Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2023; 15(12): 2111-2119
Published online Dec 15, 2023. doi: 10.4251/wjgo.v15.i12.2111
The efficacy of full-thickness endoscopic resection of subepithelial tumors in the gastric cardia
En-Pan Xu, Zhi-Peng Qi, Bing Li, Zhong Ren, Ming-Yan Cai, Shi-Lun Cai, Zhen-Tao Lyv, Zhang-Han Chen, Jing-Yi Liu, Qiang Shi, Yun-Shi Zhong
En-Pan Xu, Zhi-Peng Qi, Bing Li, Zhong Ren, Ming-Yan Cai, Shi-Lun Cai, Zhen-Tao Lyv, Zhang-Han Chen, Jing-Yi Liu, Qiang Shi, Yun-Shi Zhong, Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
Co-first authors: En-Pan Xu and Zhi-Peng Qi.
Co-corresponding authors: Qiang Shi and Yun-Shi Zhong.
Author contributions: Xu EP and Qi ZP contributed equally to this work; Zhong YS and Shi Q designed the research study; Ren Z, Cai MY, Lyu ZT, Chen ZH and Liu JY performed the research; Xu EP, Qi ZP and Li B analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript. Xu EP and Qi ZP contributed equally to this work as co-first authors. Zhong YS and Shi Q contributed equally to this work as co-corresponding authors. The reasons for designating Zhong YS and Shi Q as co-corresponding authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Third, Zhong YS and Shi Q contributed efforts of equal substance throughout the research process. The choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. The are two reasons for designating Xu EP and Qi ZP as co-first authors. First, Qi ZP participated in the writing and revision of the manuscript and provided opinions during the writing process. Furthermore, the data results were analyzed with the help of Qi ZP. In summary, we believe that designating Zhong YS and Shi Q as co-corresponding authors and Xu EP and Qi ZP as co-first authors of is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by National Natural Science Foundation of China, No. 82273025; China Postdoctoral Science Foundation, No. 2022TQ0070 and No. 2022M710759; and Shanghai Municipal Commission of Science and Technology, No. 22JC1403003 and No. 22S31903800.
Institutional review board statement: This study was approved by the Institutional Review Board of Zhongshan Hospital (Approval No. B2020-265).
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at zhong.yunshi@zs-hospital.sh.cn.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Shi Zhong, MD, PhD, Doctor, Surgeon, Endoscopy Center, Zhongshan Hospital Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. zhong.yunshi@zs-hospital.sh.cn
Received: September 10, 2023
Peer-review started: September 10, 2023
First decision: October 13, 2023
Revised: October 18, 2023
Accepted: October 30, 2023
Article in press: October 30, 2023
Published online: December 15, 2023
Processing time: 95 Days and 0.2 Hours
Abstract
BACKGROUND

Gastric subepithelial tumors (SETs) may harbor potential malignancy. Although it is well recognized that large SETs should be resected, the precise treatment strategy remains controversial. Compared to surgical resection, endoscopic resection (ER) has many advantages; however, ER of SETs in the cardia is challenging.

AIM

To evaluate the safety and efficacy of endoscopic full-thickness resection (EFTR) for the treatment of gastric cardia SETs.

METHODS

We retrospectively reviewed data from all patients with SETs originating from the muscularis propria layer in the gastric cardia that were treated by EFTR or submucosal tunneling ER (STER) at Zhongshan Hospital Fudan University between November 2014 and May 2022. Baseline characteristics and clinical outcomes, including procedure times and complications rates, were compared between groups of patients receiving EFTR and STER.

RESULTS

A total of 171 tumors were successfully removed [71 (41.5%) tumors in the EFTR and 100 (58.5%) tumors in the STER group]. Gastrointestinal stromal tumors (GISTs) were the most common SET. The en bloc resection rate was 100% in the EFTR group vs 97.0% in STER group (P > 0.05). Overall, the EFTR group had a higher complete resection rate than the STER group (98.6% vs 91.0%, P < 0.05). The procedure time was also shorter in the EFTR group (44.63 ± 28.66 min vs 53.36 ± 27.34, P < 0.05). The most common major complication in both groups was electrocoagulation syndrome. There was no significant difference in total complications between the two groups (21.1% vs 22.0%, P = 0.89).

CONCLUSION

EFTR of gastric cardia SETs is a very promising method to facilitate complete resection with similar complications and reduced operative times compared to STER. In cases of suspected GISTs or an unclear diagnosis, EFTR should be recommended to ensure complete resection.

Keywords: Endoscopic full-thickness resection, Submucosal tunneling endoscopic resection, Gastrointestinal stromal tumor, Gastric cardia, Gastric subepithelial tumors

Core Tip: Efficacy of endoscopic full-thickness resection (EFTR) is safe and effective in the treatment of cardiac subepithelial tumors. Compared with submucosal tunneling endoscopic resection, EFTR can better completely resect subepithelial tumors and provide a better pathological diagnosis. When lesions with a high index of suspicion for gastrointestinal stromal tumors are found or there is an unclear diagnosis, EFTR should be recommended to ensure complete resection.