• Gastrointestinal stromal tumor
• Laparoscopic and endoscopic cooperative surgery
• Submucosal tumor
• Tumor location

• Humans
• Gastrointestinal Stromal Tumors/surgery
• Laparoscopy/methods
• Retrospective Studies
• Male
• Female
• Middle Aged
• Aged
• Stomach Neoplasms/surgery
• Treatment Outcome
• Length of Stay
• Cohort Studies
• Adult
• Postoperative Complications/epidemiology
• Gastrectomy/methods

• Laparoscopic endoscopic cooperative surgery
• Sleeve gastrectomy
• Subepithelial lesion

• Endoscopic full-thickness resection
• Endoscopic resection
• Gastric subepithelial tumor
• NESS-EFTR
• Submucosal tunneling

• 2310780 National Cancer Center

• LECs
• endoscopy
• gastrointestinal stromal tumors (GISTs)
• risk evaluation (RE)
• surgery

• endophytic type
• endoscopic submucosal excision (ESE)
• endoscopic “calabash” ligation and resection (ECLR)
• gastric stromal tumor (GST)
• muscularis propria

• Adjuvant therapy
• GIST
• Gastrointestinal stromal tumor
• Metastases
• Neoadjuvant therapy
• Sarcoma
• Surgery

To compare the effectiveness and safety of endoscopic closure and laparoscopic repair for gastric wall defection.

The clinical data of 120 patients with submucosal tumours enrolled at our hospital between January 2014 and December 2019 were retrospectively analysed. Patients were divided into two groups according to the surgery they underwent: an endoscopic closure group (n = 60) and a laparoscopic repair group (n = 60). The clinical characteristics, perioperative complications, and postoperative follow-up results of the two groups were analysed.

The surgery time in the endoscopic closure group was 56.20 ± 11.25 minutes, which was significantly lower compared with that in the laparoscopic repair group (159.35 ± 23.18 minutes; P < 0.001). In addition, the postoperative stay in the endoscopic closure group was shorter than that in the laparoscopic repair group, and the intraoperative bleeding volume and incidence of enteral nutrition initiation after surgery were significantly lower. Medical expenses were also significantly lower in the endoscopic closure group than in the laparoscopic repair group (P < 0.001). Only one patient developed a postoperative fever in the endoscopic closure group; three patients developed a postoperative fever and one patient had postoperative bleeding in the laparoscopic repair group. However, there were no statistical differences between the two groups regarding the incidence of R0 resection, postoperative fever, postoperative bleeding, and closure failure (all P > 0.05). There were no local recurrences, distant metastases, or deaths in either of the groups during the two-year follow-up period.

Non-laparoscopic-assisted surgery may be quicker, safer, and more effective for gastric wall defection.

Exposed endoscopic full-thickness resection (EFTR), with or without laparoscopic assistance, is an emergent natural orifice transluminal endoscopic surgery technique with promising safety and efficacy for the management of gastrointestinal submucosal tumors (SMTs) arising from the muscularis propria (MP), especially of the gastric wall. To date, evidence concerning duodenal exposed EFTR is lacking, mainly due to both the technical difficulty involved because of the special duodenal anatomy and concerns about safety and effectiveness of transmural wall defect closure. However, given the non-negligible morbidity and mortality associated with duodenal surgery, the recent availability of dedicated endoscopic tools for tissue-approximation capable to realize full-thickness defect closure could help in promoting the adoption of this endosurgical technique among referral centers. The aim of our study was to review the current evidence concerning exposed EFTR with or without laparoscopic assistance for the treatment of MP-arising duodenal SMTs.

• Endoscopic full-thickness resection
• Exposed endoscopic full-thickness resection
• Laparoscopy-assisted endoscopic full-thickness resection
• Duodenal submucosal tumors
• Novel oral transluminal endoscopic surgery

Laparoscopic endoscopic cooperative surgery (LECS) refers to the endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection. We recommend a treatment algorithm for the LECS procedure for gastric benign tumors according to the protruding type. In the exophytic type, endoscopic-assisted wedge resection can be performed. In the endophytic type, endoscopic-assisted wedge resection of the anterior wall is relatively easy to perform, and endoscopic-assisted transgastric resection, laparoscopic-assisted intragastric surgery, or single-incision intragastric resection in the posterior wall and esophagogastric junction (EG Jx) can be attempted. We propose an algorithm for the LECS procedure for early gastric cancer according to the tumor location. The endoscopic submucosal dissection (ESD) procedure can be adapted for all areas of the stomach, and single-incision ESD can be performed in the mid to high body and the EG Jx. In full-thickness gastric resection, laparoscopy-assisted endoscopic full-thickness resection can be adapted for the entire area of the stomach, but it cannot be applied to the pyloric and EG Jx. In conclusion, surgeons need to select the LECS procedure according to tumor type, tumor location, the surgeon's individual experience, and the situation of the institution while also considering the advantages and disadvantages of each procedure.

• Endoscopes
• Laparoscopy

• SMT
• esophagogastric junction
• single-incision LIGS

Nonexposure simple suturing endoscopic full-thickness resection (NESS-EFTR) is a recently developed method to prevent the exposure of tumor cells, and we performed a small prospective trial of NESS-EFTR for gastric subepithelial tumors (SETs). In this study, we compared the results of NESS-EFTR trial with those of another small prospective trial of laparoscopic and endoscopic cooperative surgery which was performed in different time period. The results of this study show the feasibility of NESS-EFTR for gastric SETs and provide evidence for the clinical application of the NESS-EFTR procedure.

Recently, nonexposure simple suturing endoscopic full-thickness resection (NESS-EFTR) method was developed to avoid tumor exposure to the peritoneal cavity. The aim of this study is to compare the short-term outcomes of the NESS-EFTR method with those of laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumors (SETs). A prospective single-center trial of LECS for gastric SETs was performed from March 2012 to October 2013 with a separate prospective trial of NESS-EFTR performed from August 2015 to June 2017, enrolling 15 patients each. Among the 30 enrolled patients, 14 who underwent LECS and 11 who underwent NESS-EFTR were finally included in the analysis. The rate of complete resection and successful closure was 100% in both groups. The operating time was longer for NESS-EFTR group than for LECS (110 vs. 189 min; p < 0.0001). There were no postoperative complications except one case of transient fever in the NESS-EFTR group. One patient in the LECS group had peritoneal seeding of gastrointestinal stromal tumor at 17 months postoperatively, and there was no other recurrence. Although NESS-EFTR had long operating and procedure times, it was feasible for patients with gastric SETs requiring a nonexposure technique.

• early gastric cancer
• endoscopic full-thickness resection
• laparoscopic and endoscopic cooperative surgery
• nonexposure technique

In recent years, a wide range of gastrointestinal endoscopy techniques have been developed, such as endoscopic submucosal dissection (ESD) and endoscopic retrograde cholangiopancreatography (ERCP). Although ESD and ERCP have an important role in gastrointestinal and biliary diseases, each technique has its limitations. Hybrid techniques that combine endoscopic and surgical procedures have emerged that have the advantages of different procedures and negate their limitations at the same time. Laparoscopic endoscopic cooperative surgery and modified laparoscopic endoscopic cooperative surgery combine ESD and laparoscopic techniques to resect submucosal tumors with minimum resection area. Air leak test by intraoperative endoscopy can effectively identify a mechanically insufficient anastomosis and decrease the complication rate. The rendezvous technique that combines percutaneous transhepatic biliary drainage and endoscopy can be performed as a rescue approach for the treatment of biliary obstruction, stenosis and bile duct injuries. For patients with simultaneous presence of stones in the gallbladder and the common bile duct, the laparo-endoscopic rendezvous technique can perform ERCP and laparoscopic cholecystectomy at the same time and reduces the risk of pancreatic injury caused by ERCP. Biliobiliary and bilioenteric anastomosis using magnetic compression anastomosis is another choice for biliary obstruction. The most common used approach to deliver the magnets is by percutaneous-peroral tract. Laparoscopic-assisted ERCP is a safe and highly effective therapy for patients who develop biliary diseases after Roux-en-Y gastric bypass surgery.

• Hybrid technique
• Laparoscopic and endoscopic cooperative surgery
• Endoscopic retrograde cholangiopancreatography
• Laparoscopic-assisted endoscopic retrograde cholangiopancreatography
• Rendezvous technique
• Magnetic compression anastomosis

• endoscopy
• fine needle aspiration
• mesenchymal tumor
• schwannoma
• stomach

• Gastrointestinal stromal tumors
• Natural orifice endoscopic surgery
• Stomach neoplasms

• Endoscopic full-thickness resection
• Muscularis propria
• Submucosal tumor
• Thread-traction

• Dissection/adverse effects
• Dissection/methods
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Feasibility Studies
• Female
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/surgery
• Humans
• Intraoperative Complications/therapy
• Leiomyoma/pathology
• Leiomyoma/surgery
• Male
• Middle Aged
• Operative Time
• Retrospective Studies
• Stomach/pathology
• Stomach/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome
• Tumor Burden

• Early gastric cancer
• Facility-based
• Gastrointestinal stromal tumor
• Laparoscopic and endoscopic cooperative surgery
• Minimally invasive surgery

• obesity
• sleeve gastrectomy
• quality of life
• bariatric surgery
• obesidade
• gastrectomia vertical
• qualidade de vida
• cirurgia bariátrica

• Feasibility Studies
• Gastrectomy/methods
• Gastrostomy
• Humans
• Laparoscopy
• Obesity, Morbid/surgery
• Surgical Staplers

• Endoscopic Full Thickness Resection
• Full Thickness Resection Device
• Subepithelial Lesions
• Submucosal Tunneling Endoscopic Resection

• endoscopic full-thickness resection
• endoscopic resection
• gastric submucosal tumor
• laparoscopic endoscopic cooperative surgery (LECS)
• laparoscopic resection

• Endoscopic full-thickness resection
• Laparoscopic and endoscopic cooperation surgery
• Non-exposed endoscopic wall-inversion surgery
• Non-exposure simple suturing endoscopic full-thickness resection

• EFTR
• ESD
• Endoscopic full-thickness resection
• Endoscopic submucosal dissection
• Endoscopy
• GIST
• Gastrointestinal stromal tumor
• Laparoscopy

• Aged
• Aged, 80 and over
• Endoscopic Mucosal Resection/methods
• Feasibility Studies
• Female
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/surgery
• Gastroscopy/methods
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local/epidemiology
• North America
• Retrospective Studies
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome

Endoscopy has developed rapidly, generating new challenges. Today, there are several procedures done endoscopically with very good results. In the past, the assisted laparoscopic colon polypectomy has been described, reducing the morbidity of a bigger procedure. Nonetheless, little has been said about the use of hybrid surgery in the management of gastric or duodenal polyps.

Evaluating the safety and efficacy of the assisted laparoscopic gastric endoscopic polypectomy.

A retrospective review of the database at our two centres was performed from 1996 to 2014. Thirteen patients were found in whom an assisted laparoscopic gastric or duodenal endoscopic tumour resection was performed.

Thirteen patients, eight males and five females, with a median age of 61 years and average body mass index of 29.3. The procedure was done effectively and no need for further procedures was required for any patient. No complications were reported in the early post-operative period.

The study shows that assisted laparoscopic gastric endoscopic polypectomy is a feasible and safe procedure that can be used for the management of giant polyps, which cannot be resected with the classical endoscopic polypectomy reducing the morbidity and complications associated with larger procedures.

• Endoscopic appendectomy
• Endoscopic full-thickness resection (eFTR)
• Full-thickness resection device (FTRD®)
• Non-lifting adenoma
• Recurrent adenoma

Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Due to its rarity, GS is not widely recognized by clinicians, and the precise differential diagnosis between GS and other gastric submucosal tumors remains difficult preoperatively. The present study reports a case of GS misdiagnosed as gastrointestinal stromal tumor and reviews the clinical, imaging, and pathological features, treatment, and follow-up of 221 patients with GS previously reported in the English literature. Although GS is rare, the case reported in the current study highlights the importance of including GS in differential diagnoses of gastric submucosal tumors. Furthermore, the findings of the review suggest that although many cases are asymptomatic, the most common symptoms are abdominal pain or discomfort, not gastrointestinal bleeding, and malignant GSs present with clinical symptoms more commonly. Although large-sample multicenter studies on the efficacy, safety, and oncological outcomes of minimally invasive techniques are required, the findings presented herein may be helpful for clinicians when diagnosing or treating GS.

• Endoscopic submucosal dissection (ESD)
• early gastrointestinal cancer
• gastric subepithelial tumors (SETs)
• gastric submucosal tumors (SMTs)
• gastrointestinal stromal tumor (GIST)
• laparoscopic and endoscopic cooperative surgery (LECS)

• Endoscopy
• gastrointestinal
• laparoscopy
• stomach neoplasms
• subepithelial tumors

• Endoscopic submucosal dissection
• stomach
• subepithelial tumour
• surgical resection

Gastrointestinal stromal tumors (GISTs) constitute the most common mesenchymal neoplasms of the gastrointestinal tract, among which 60%-70% are located in the stomach. All GISTs have malignant potential, varying from small lesions to aggressive sarcomas. Surgical resection with negative margins remains the best treatment for GISTs. Lymphadenectomy is not necessary because GISTs rarely metastasize to lymph nodes. Because of these biological behavior characteristics, the advantages of minimally invasive surgeries such as laparoscopic surgery and endoscopic surgery can be fully reflected in the surgical management of GISTs. The advent of laparoscopic and endoscopic cooperative surgery has broadened the scope and enhanced the safety of minimally invasive surgical treatment of GISTs. In this paper we will discuss the application of laparoscopy, endoscopy and laparoscopic and endoscopic cooperative surgery in the treatment of GISTs.

• Gastrointestinal stromal tumors
• Laparoscopy
• Endoscopy

Gastrointestinal stromal tumors (GISTs) are considered to be potentially malignant mesenchymal tumors of the gastrointestinal tract. Clinically relevant GISTs are rare; however, subclinical GISTs (mini‐GISTs) (1‐2 cm) and pathologic GISTs (micro‐GISTs) (<1 cm) are frequently reported. Most mini‐GISTs and almost all micro‐GISTs of the stomach may exhibit benign clinical behavior, and only mini‐GISTs with high‐risk features may progress. For this review, a provisional algorithm was used to propose diagnostic and treatment strategies for patients with small GISTs. Because surgery is the only potentially curative treatment, in its application for small GISTs, the principles of sarcoma surgery should be maintained, and cost effectiveness should be considered. Indications for surgery include GISTs measuring ≥2 cm, symptomatic GISTs, and mini‐GISTs with high‐risk features (irregular borders, cystic spaces, ulceration, echogenic foci, internal heterogeneity, and tumor progression during follow‐up); however, a preoperative pathologic diagnosis is infrequently obtained. For small intestinal and colorectal GISTs, surgery is indicated irrespective of size because of their greater malignant potential. Otherwise, mini‐GISTs without high‐risk features, micro‐GISTs, and small submucosal tumors measuring <5 cm without high‐risk features may be followed by periodical endoscopic ultrasonography. Although surgical approaches and operative methods are selected according to tumor size, location, growth pattern, and surgical teams, laparoscopic surgery has produced similar oncologic outcomes and is less invasiveness compared with open surgery. After resection, pathologic examination for diagnosis and risk assessment is mandatory, and genotyping is also recommended for high‐risk GISTs. Endoscopic resection techniques, although feasible, are not routinely indicated for most mini‐GISTs or micro‐GISTs. Cancer 2016;122:3110–8. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Gastrointestinal stromal tumors (GISTs) are potentially malignant, and endoscopic ultrasonography and endoscopic ultrasound‐guided fine‐needle aspiration may play a major role in the diagnosis of small GISTs and submucosal tumors. Surgery is indicated for all intestinal GISTs and for small gastric GISTs in patients who have symptoms and/or high‐risk features.

• endoscopic ultrasonography (EUS)
• gastrointestinal stromal tumor (GIST)
• high-risk features
• laparoscopic surgery
• submucosal tumor (SMT)

•

There are several endoscopic, laparoscopic and open surgical procedures available for the management of GIST tumors near the GE junction.

The safety and oncologic outcome of laparoscopic gastric GIST resection is well established especially for lesions <5 cm in diameter. The optimal management of GIST tumors near the GE junction remains unclear.

We present a case-report of a 4.7 cm GIST tumor near the GE junction managed by endoscopically-assisted laparoscopic wedge resection (EAWR). We present a review of the literature highlighting the various combined laparo-endoscopic techniques available.

We used the non-touch lesion-lifting method to laparoscopically resect the GIST tumor under endoscopic guidance. There were no complications and the patient was discharged on postoperative day 3.

Endoscopically-assisted laparoscopic wedge resections are feasible and safe for GIST tumors near the GE junction.

• GIST tumors
• Gastroesophageal junction tumors
• Laparo-endoscopic resection
• Laparoscopic wedge resection

With the wide use of esophagogastroduodenoscopy, the incidence of gastric subepithelial tumor (SET) diagnosis has increased. While the management of large or symptomatic gastric SETs is obvious, treatment of small (≤ 3 cm) asymptomatic gastric SETs remains inconclusive. Moreover, the presence of gastrointestinal stromal tumors with malignant potential is of concern, and endoscopic treatment of gastric SETs remains a subject of debate. Recently, numerous studies have demonstrated the feasibility of endoscopic treatment of gastric SETs, and have proposed various endoscopic procedures including endoscopic submucosal dissection, endoscopic muscularis dissection, endoscopic enucleation, endoscopic submucosal tunnel dissection, endoscopic full-thickness resection, and a hybrid approach (the combination of endoscopy and laparoscopy). In this review article, we discuss current endoscopic treatments for gastric SETs as well as the advantages and limitations of this type of therapy. Finally, we predict the availability of newly developed endoscopic treatments for gastric SETs.

• Subepithelial tumor
• Endoscopy
• Stomach
• Treatment
• Complication

• Combination of laparoscopic and endoscopic approaches for neoplasia with a nonexposure technique
• Full-thickness resection
• Gastrointestinal stromal tumor
• Laparoscopic and endoscopic cooperative surgery
• Laparoscopic transgastric surgery
• Laparoscopy-assisted endoscopic full-thickness resection
• Laparoscopy-assisted endoscopic resection
• Nonexposed endoscopic wall-inversion surgery

• Endoscopic submucosal dissection
• Laparoscopic endoscopic cooperative surgery
• Nonexposed endoscopic wall-inversion surgery
• Sentinel node navigation surgery

• Endoscopy
• Gastric submucosal tumor
• Intragastric approach
• Minilaparoscopy
• Pig
• Single-incision surgery

Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors.

Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy.

All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was 139.2±30.9 minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was 7.7±0.8 days.

ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.

• Esophagogastric junction
• Gastric submucosal tumor

AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.

METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach.

RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described.

CONCLUSION: Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.

• Cooperative laparoscopic endoscopic
• Hybrid laparoscopic
• Laparoscopic endoscopic cooperative surgery
• Endoscopy
• Laparoscopy
• Minimally invasive surgery
• Gastrointestinal stromal tumors
• Gastric cancer
• Submucosal tumor

• Duodenal Neoplasms/pathology
• Duodenal Neoplasms/surgery
• Duodenoscopy/adverse effects
• Duodenoscopy/methods
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/surgery
• Gastroscopy/adverse effects
• Gastroscopy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome

Laparoscopic wedge resection is a useful procedure for treating patients with submucosal tumor (SMT) including gastrointestinal stromal tumor (GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery (LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

• Cooperative surgery
• Endoscopy
• Gastrointestinal tumor
• Laparoscopy
• Submucosal tumor

• Early gastric cancer
• Endoscopic full-thickness resection
• Subepithelial extent

Background and Aims. Endoscopic submucosal dissection (ESD) has been accepted as a treatment modality for gastrointestinal epithelial tumors. Recently, ESD has been applied to resect subepithelial tumors (SETs) in the gastrointestinal tract, but clinical evidence on its efficacy and safety is limited. The aim of this study was to investigate the efficacy and safety of ESD for gastric SETs and to assess possible predictive factors for incomplete resection. Patients and Methods. Between January 2006 and December 2013, a total of 49 patients with gastric SET underwent ESD at our hospital. Clinicopathologic characteristics of patients and SETs, therapeutic outcomes, complications, and follow-up outcomes were evaluated. Results. The overall rates of en bloc resection and complete resection were 88% (43/49) and 84% (43/49), respectively. Complete resection rates in tumors originating from the submucosal layer were significantly higher than those in tumors originating from the muscularis propria layer (90% versus 56%, P = 0.028). In multivariate logistic regression analyses, tumor location (upper third: odds ratio [OR] 12.639, 95% confidence interval [CI] 1.087–146.996, P = 0.043) and layer of tumor origin (muscularis propria: OR 8.174, 95% CI 1.059–63.091, P = 0.044) were independently associated with incomplete resection. Procedure-related bleeding and perforation rates were both 4%. No recurrence was observed in patients with complete resection at a median follow-up period of 29 months (range: 7–83 months). Conclusions. ESD is an effective, safe, and feasible treatment for gastric SETs. The frequency of incomplete resection increases in tumors located in the upper third of the stomach and in those originating from the muscularis propria layer.

• Clips assisted with foreign body forceps clip method (CFCM)
• Defect closure
• Endoloop string suture method (ESSM)
• Endoscopic full-thickness resection (EFR)
• Gastric submucosal tumor (SMT)