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Lin KF, Chen CC, Chen CC, Han ML, Wang HP, Wu MS, Tseng PH. Clinical characteristics and esophageal motility in patients with gastric cardia submucosal tumors and associated changes after endoscopic resection. Surg Endosc 2025; 39:1961-1971. [PMID: 39870828 DOI: 10.1007/s00464-025-11562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 01/14/2025] [Indexed: 01/29/2025]
Abstract
BACKGROUND This study aimed to investigate the clinical characteristics and esophageal motility of patients with gastric cardia submucosal tumors (SMTs) and the associated changes after endoscopic resection based on high-resolution impedance manometry (HRIM). METHODS From our electronic database, we identified patients who underwent pre-operative evaluation of gastric cardia SMTs between 2015 and 2023. All patients completed standardized symptom questionnaires and underwent endoscopic ultrasonography and HRIM. Endoscopic resection via submucosal dissection or submucosal tunnel endoscopic resection was performed, followed by esophagogastroduodenoscopy and HRIM three months later. Esophageal motility on HRIM was compared based on the updated Chicago Classification v4.0. RESULTS Thirty patients (mean age, 47.4 ± 12.8 years; male, 50%) were analyzed. Most patients were asymptomatic (43.3%), while others presented with epigastralgia, regurgitation, chest pain, or dysphagia. On endoscopic ultrasonography, the average tumor size was 16.7 ± 4.5 mm (range, 10.0-30.0 mm), and most tumors originated from the fourth layer (80%). On HRIM, eight patients (26.7%) had abnormal esophageal motility, including five with ineffective esophageal motility (IEM) and three with esophagogastric junction outflow obstruction. Complete resection was achieved in 25 of the 27 patients (92.6%) who underwent endoscopic treatment. Pathology revealed leiomyomas (96%) and gastrointestinal stromal tumors (4%). No significant differences in symptom profiles or HRIM parameters were observed after tumor resection. Three patients with pre-operative IEM exhibited normal motility at the follow-up HRIM. CONCLUSION Up to 26.7% of patients with gastric cardia SMTs had abnormal esophageal motility on HRIM. Endoscopic resection of these SMTs was effective and safe and appeared to improve esophageal motility in patients with IEM.
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Affiliation(s)
- Kuang-Fang Lin
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan
| | - Chien-Chuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan
| | - Ming-Lun Han
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan
- Endoscopic Division, Department of Integrated Diagnostic & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan.
- Endoscopic Division, Department of Integrated Diagnostic & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
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Li P, Tang GM, Li PL, Zhang C, Wang WQ. Endoscopic resection of a giant irregular leiomyoma in fundus and cardia: A case report. World J Gastrointest Endosc 2024; 16:678-685. [PMID: 39735393 PMCID: PMC11669962 DOI: 10.4253/wjge.v16.i12.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/26/2024] [Accepted: 10/10/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Endoscopic resection of giant gastric leiomyomas, particularly in the fundus and cardia regions, is infrequently documented and presents a significant challenge for endoscopic surgery. CASE SUMMARY Herein, a case of a 59-year-old woman with a giant gastric leiomyoma was reported. The patient presented to the department of hepatological surgery with a complaint of right upper abdominal pain for one month and worsening for one week. The patient was diagnosed as gastric submucosal tumor (SMT), gallstone, and cholecystitis combined with computed tomography and gastroendoscopy prior to operation. Upon admission, following a multi-disciplinary treatment discussion, it was determined that the patient would undergo a laparoscopic cholecystectomy and endoscopic resection of gastric SMT. It took 3 hours to completely resect the lesion by Endoscopic submucosal excavation and endoscopic full-thickness resection, and about 3 hours to suture the wound and take out the lesion. The lesion, ginger-shaped and measuring 8 cm × 5 cm, led to transient peritonitis post-surgery. With no cardiac complications, the patient was discharged one week after surgery. CONCLUSION Endoscopic resection of a giant leiomyoma in the cardiac fundus is feasible and suitable for skilled endoscopists.
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Affiliation(s)
- Peng Li
- Department of Gastroenterology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Guang-Ming Tang
- Department of Gastroenterology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Pei-Lin Li
- Department of Hepatological Surgery, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Chun Zhang
- Department of Pathology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
| | - Wei-Qiang Wang
- Department of Gastroenterology, Central Hospital Affiliated to Chongqing University of Technology, Chongqing 400054, China
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Fan B, Zhong K, Chen Z. Clinical observation of laparoscopic seromuscular dissection in the treatment of gastric stromal tumors. MINIM INVASIV THER 2023; 32:329-334. [PMID: 37452645 DOI: 10.1080/13645706.2023.2228402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the safety and oncological prognosis of laparoscopic seromuscular dissection (LSD) in the treatment of gastric stromal tumors. MATERIAL AND METHODS From June 2016 to July 2022, 67 patients with gastric stromal tumors underwent laparoscopic seromuscular dissection (LSD), and 58 patients underwent non-LSD surgery during the same period (52 patients underwent laparoscopic gastric wedge resection (LWR), two patients underwent proximal gastrectomy, three patients underwent total gastrectomy, one patient underwent distal gastrectomy and partial hepatectomy). Gastric stromal tumor patients were compared to compare the surgical results, tumor relapse rate, and survival rate of the two groups. RESULTS The results of the two groups were compared. For gastric stromal tumors, especially gastric stromal tumors located at 'difficult sites', LSD can reduce the amount of bleeding and the number of cutting staplers used during the operation, reduce the incidence of postoperative complications, shorten the postoperative hospitalization time, reduce the hospitalization cost and improve the quality of life of patients without increasing the operation time. CONCLUSION Laparoscopic seromuscular dissection for gastric stromal tumors is safe and technically feasible in the hands of experienced laparoscopic surgeons.
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Affiliation(s)
- Baohang Fan
- Second Clinical Medical College of Jinan University, Guangzhou, China
| | - Keli Zhong
- Department of Gastrointestinal Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Zhao Chen
- Second Clinical Medical College of Jinan University, Guangzhou, China
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Kim SM, Kim EY, Cho JW, Jeon SW, Kim JH, Kim TH, Moon JS, Kim JO. Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study. Clin Endosc 2021; 54:872-880. [PMID: 34788936 PMCID: PMC8652168 DOI: 10.5946/ce.2021.251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.
Methods We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.
Results Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.
Conclusions The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.
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Affiliation(s)
- Sun Moon Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Tae Hyeon Kim
- Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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Kim GH, Ahn JY, Gong CS, Kim M, Na HK, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Efficacy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Gastric Subepithelial Tumors Located in the Cardia. Dig Dis Sci 2020; 65:583-590. [PMID: 31410755 DOI: 10.1007/s10620-019-05774-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In cases of subepithelial tumors (SETs) located in the cardiac area, a preoperative histologic diagnosis might be helpful in determining the requirement of surgery. AIM To investigate the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in gastric SETs located in the cardia. METHODS The data of 107 patients who underwent EUS-FNB, from 2012 to 2017, for tissue sampling of gastric SETs located in the cardia were collected. The clinicopathological data, EUS-related parameters, and surgical outcomes were retrospectively reviewed. RESULTS The EUS-FNB results were diagnostic in 86.9% (93/107) and nondiagnostic in 13.1% (14/107) of the patients. Immunostaining of the FNB specimens led to the diagnosis of gastrointestinal stromal tumor (GIST) in 25 SETs (23.4%), leiomyoma in 62 SETs (57.9%), heterotopic pancreas in 3 SETs (2.8%), and schwannoma in 2 SETs (1.9%). In the multivariate analysis, patients with GISTs showed significantly more inhomogeneous echogenicity [odds ratio (OR), 8.867], more cystic foci (OR, 26.98), and older age (OR, 1.087). In 26 patients who underwent surgical resection, the agreement between EUS-FNB and surgical pathological findings was 100% with respect to the diagnosis of GISTs (n = 20) and leiomyoma (n = 7). Among these cases, the proportion of high-risk GISTs was 20.0% (4/20), and no leiomyosarcoma was detected. CONCLUSIONS Although a majority of the subepithelial lesions in the cardia of the stomach are benign, 20% of the cases diagnosed with GIST have a high malignant potential. Preoperative EUS-FNB might be a useful tool for decision-making regarding the ultimate management and outcomes of these lesions.
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Affiliation(s)
- Ga Hee Kim
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Chung Sik Gong
- Department of Gastric Surgery, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Mimi Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Kim SY, Shim KN, Lee JH, Lim JY, Kim TO, Choe AR, Tae CH, Jung HK, Moon CM, Kim SE, Jung SA. Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors. Clin Endosc 2019; 52:565-573. [PMID: 31311912 PMCID: PMC6900302 DOI: 10.5946/ce.2019.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Endoscopic ultrasonography (EUS) is the most efficient imaging modality for gastric subepithelial tumors (SETs). However, abdominopelvic computed tomography (APCT) has other advantages in evaluating the characteristics, local extension, or invasion of SETs to adjacent organs. This study aimed to compare the diagnostic ability of EUS and APCT based on surgical histopathology results.
Methods We retrospectively reviewed data from 53 patients who underwent both EUS and APCT before laparoscopic wedge resection for gastric SETs from January 2010 to December 2017 at a single institution. On the basis of histopathology results, we assessed the diagnostic ability of the 2 tests.
Results The overall accuracy of EUS and APCT was 64.2% and 50.9%, respectively. In particular, the accuracy of EUS vs. APCT for the diagnosis of gastrointestinal stromal tumors (GISTs), leiomyomas, and ectopic pancreas was 83.9% vs. 74.2%, 37.5% vs. 0.0%, and 57.1% vs. 14.3%, respectively. Most of the incorrect diagnoses with EUS involved hypoechoic lesions originating in the fourth echolayer, with the most common misdiagnosed lesions being GISTs mistaken for leiomyomas and vice versa.
Conclusions APCT showed a lower overall accuracy than EUS; however, APCT remains a useful modality for malignant/potentially malignant gastric SETs.
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Affiliation(s)
- Sang Yoon Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Joo-Ho Lee
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ji Young Lim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - A Reum Choe
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Ko SY, Lee JS, Kim JJ, Park SM. Higher incidence of gastroesophageal reflux disease after gastric wedge resections of gastric submucosal tumors located close to the gastroesophageal junction. Ann Surg Treat Res 2014; 86:289-94. [PMID: 24949319 PMCID: PMC4062447 DOI: 10.4174/astr.2014.86.6.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/06/2014] [Accepted: 02/12/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose We hypothesized that gastroesophageal reflux disease (GERD) would be more prevalent after a gastric wedge resection of a submucosal tumor (SMT) located close to the gastroesophageal junction (GEJ) than after a gastric wedge resection of an SMT at other locations because of the damage to the lower esophageal sphincter during surgery. Methods Fifty-eight patients with gastric SMT who underwent open or laparoscopic gastric wedge resection between January 2000 and August 2012 at the Department of Surgery, Incheon St. Mary's Hospital were enrolled into this study. The patients were divided into 2 groups according to the location of the tumor, upper or lateral border of the tumor within 5 cm of the GEJ (GEJ ≤ 5 cm group) and upper or lateral border of the tumor greater than 5 cm distal to the GEJ (GEJ > 5 cm group). The surgical records, clinicopathologic findings, postoperative GERD symptoms, postoperative use of acid suppressive medications and preoperative and postoperative endoscopic findings were retrospectively reviewed and compared between the 2 groups. Results There was no difference in the frequency of the preoperative GERD symptoms between the 2 groups, whereas postoperative GERD symptoms and postoperative use of acid suppressive medications were more frequent in the GEJ ≤ 5 cm group (P = 0.045 and P = 0.031). However, there were no differences in the follow-up endoscopic findings in terms of reflux esophagitis and Hill's grade between the 2 groups. Conclusion The incidence of GERD was higher after gastric wedge resection of SMTs located close to the GEJ. Hence, adequate care should be taken during the follow-up of these patients.
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Affiliation(s)
- Seung Yeon Ko
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Jeong Sun Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Jin-Jo Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Seung-Man Park
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
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Kim DJ, Lee JH, Kim W. Laparoscopic resection for 125 gastroduodenal submucosal tumors. Ann Surg Treat Res 2014; 86:199-205. [PMID: 24783179 PMCID: PMC3996721 DOI: 10.4174/astr.2014.86.4.199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/01/2013] [Accepted: 11/15/2013] [Indexed: 02/07/2023] Open
Abstract
Purpose The present study aims to elucidate the treatment strategies of laparoscopic resection for gastroduodenal submucosal tumors (SMTs). Methods Data of 125 gastroduodenal STMs were collected retrospectively resected from August, 2004 to February, 2013. Surgical outcomes according to tumor locations, pathologic results and survival data for gastrointestinal stromal tumors (GISTs) were collected and analyzed. Results There were 55 male and 70 female patients with mean age 57.9 ± 12.7 years old. Mean tumor size of gastric SMTs was 2.7 ± 1.64 cm (range, 0.4-8.5 cm). GIST was the most common (n = 70, 56%). Regarding the tumor location, all the fundic lesions were GISTs and leiomyoma was occurred 58.8% of cardiac lesions. Ectopic pancreas and schwannomas were mostly located at body portion, 73% and 80%, respectively. SMTs located at duodenal bulb comprise 4 GISTs and 3 carcinoids. Surgical results comparing between lesions located at cardia, near-pylorus and else had no difference in operation time, hospital stay and complications. In terms of outcome of GIST, all patients underwent curative resection except one case of peritoneal sarcomatosis. There was one recurrence in a high risk group following resection. The cumulative 5-year disease free survival rate was 93.5% in all GISTs. There were two postoperative complications, one gastric outlet obstruction and one leakage following wedge resection. Conclusion Laparoscopic wedge resection is a safe and feasible procedure for the small to medium sized gastroduodenal SMTs even their locations are near cardia or pylorus.
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Affiliation(s)
- Dong Jin Kim
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jun Hyun Lee
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Sun C, He Z, Zheng Z, Yu Q, Wang T, Liu W, Wang B. Endoscopic submucosal dissection for gastrointestinal mesenchymal tumors adjacent to the esophagogastric junction: we need to do more. J Laparoendosc Adv Surg Tech A 2013; 23:570-7. [PMID: 23631665 DOI: 10.1089/lap.2012.0462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Extensive surgery is the mainstay of therapy for patients with gastrointestinal mesenchymal tumors (GIMTs) adjacent to the esophagogastric junction (EGJ). However, this modality is invasive and may interfere with anatomic consistency of the digestive tract. Therefore, we evaluated the feasibility, safety, and efficacy of endoscopic submucosal dissection (ESD) for GIMTs close to the EGJ and factors related to incomplete resection. PATIENTS AND METHODS For 39 GIMTs adjacent to the EGJ in 39 consecutive patients, the baseline information, complications, and therapeutic outcomes were recorded. Subsequently, risk factors, focusing on age, sex, tumor size, extent, shape, perforation presence/absence, and histopathology, were analyzed. RESULTS Complete removal of junctional GIMTs was achieved in 32 cases, giving an overall complete resection rate of 82%. The mean tumor size was 16.1±12.7 (median, 12; range, 4-50) mm. There were no major intra- and postoperative complications, but two small perforations were found. The final histopathologic diagnoses included 28 leiomyomas, 10 gastrointestinal stromal tumors, and 1 schwannoma. No local recurrence or distant metastasis was observed during a mean follow-up of 15.7±8.4 (median, 16; range, 6-35) months. Univariate analysis showed incomplete resection was associated with tumor shape and size. Multivariate regression analysis identified tumor irregularity (odds ratio=37.50, 95% confidence interval=4.253-330.627) as the single factor associated with incomplete resection. CONCLUSIONS ESD is feasible and safe for well-selected patients with GIMTs adjacent to the EGJ. Irregular tumor shape should be considered as a technical difficulty while performing ESD. Oncologic outcomes need to be assessed with longer follow-up.
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Affiliation(s)
- Chao Sun
- Department of Digestive Diseases, General Hospital, Tianjin Medical University, Tianjin, China
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Kong SH, Yang HK. Surgical treatment of gastric gastrointestinal stromal tumor. J Gastric Cancer 2013; 13:3-18. [PMID: 23610714 PMCID: PMC3627804 DOI: 10.5230/jgc.2013.13.1.3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/09/2013] [Accepted: 03/10/2013] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.
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Affiliation(s)
- Seong-Ho Kong
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Li QL, Yao LQ, Zhou PH, Xu MD, Chen SY, Zhong YS, Zhang YQ, Chen WF, Ma LL, Qin WZ. Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc 2012; 75:1153-8. [PMID: 22459663 DOI: 10.1016/j.gie.2012.01.037] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 01/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Given the high morbidity and mortality rates for surgery and the diminishment of quality of life caused by operative resection of the gastric cardia, a minor invasive treatment without loss of curability is desirable for submucosal tumors (SMTs) of the esophagogastric junction (EGJ). Endoscopic submucosal dissection (ESD) has been used successfully for the removal of esophageal or gastric SMTs; however, the EGJ has been regarded as a difficult location for ESD because of its narrow lumen and sharp angle. OBJECTIVE To evaluate the clinical impact of ESD for SMTs of the EGJ arising from the muscularis propria layer. DESIGN Single-center, prospective study. SETTING Academic medical center. PATIENTS 143 patients with 143 SMTs of the EGJ originating from the muscularis propria layer. INTERVENTIONS ESD. MAIN OUTCOME MEASUREMENTS Complications, en bloc resection rate, local recurrence, and distant metastases. RESULTS The average maximum diameter of the lesions was 17.6 mm (range 5 - 50 mm). The en bloc resection rate was 94.4% (135/143). All en bloc resection lesions showed both lateral and deep tumor-free margins, including 20 GI stromal tumors. Perforations occurred in 6 patients (4.2%, 6/143), and metal clips were used to occlude the defect. Four pneumoperitoneum and 2 pneumothorax caused by perforations were resolved with nonsurgical treatment. Local recurrence and distant metastasis have not occurred during a 2-year follow-up. LIMITATIONS Single-center, short follow-up. CONCLUSIONS ESD appears to be a safe, feasible, and effective procedure for providing accurate histopathologic evaluations, as well as curative treatments for SMTs of the EGJ originating from the muscularis propria layer.
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Affiliation(s)
- Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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