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Lin H, Chen S, Tan N, Zhuang Q, Jia X, Jiang D, Xiao Y, Wang J. The efficacy and safety of submucosal tunneling endoscopic resection in treating large esophageal subepithelial lesions. Surg Endosc 2025; 39:1672-1680. [PMID: 39792189 PMCID: PMC11870968 DOI: 10.1007/s00464-024-11509-z] [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: 08/07/2024] [Accepted: 12/27/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND Submucosal tunneling endoscopic resection (STER) is considered an effective, safe and minimally invasive treatment for esophageal subepithelial lesions (SELs) with maximal dilameter less than 3.0 cm, yet its efficacy for lesions over 3.0 cm remains unclear. This study aimed to evaluate the application value of STER for SELs of varying sizes. METHODS Consecutive patients with esophageal SELs who underwent STER were retrospectively enrolled from May 2017 to March 2024. Baseline characteristics, surgical information and prognosis were collected and compared among patients with SELs of different sizes, as defined by the maximal diameter of the postoperative specimen. RESULTS A total of 133 patients were included, among whom 69 with SELs < 3.0 cm, 31 with SELs between 3.0 and 5.0 cm, 33 with SELs ≥ 5.0 cm. 1 case with SELs ≥ 5.0 cm was converted to endoscopic submucosal dissection (ESD) due to the tumor's adhesion to the epithelial layer. Among those who completed the STER procedure, the en bloc resection rate was 100.0% for all three subgroups, and the recurrence and metastasis rates were 0.0%, demonstrating that STER is effective for SELs of all sizes. However, SELs ≥ 5.0 cm were associated with more adverse events, a higher number of difficult procedures, and more frequent intensive care unit (ICU) transfers (all p < 0.050). CONCLUSIONS STER is effective and safe for treating esophageal SELs. For lesions exceeding 5 cm, while still feasible, the procedure requires meticulous planning, advanced techniques and careful monitoring due to increased complexity and risks.
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Affiliation(s)
- Huiting Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Songfeng Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Niandi Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Qianjun Zhuang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Xingyu Jia
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Dianxuan Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Yinglian Xiao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
| | - Jinhui Wang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
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Zhang L, Zhao R, Zhang J. Endoscopic semi-blunt dissection technique is safe and effective for treating gastric submucosal tumors from the muscularis propria. BMC Gastroenterol 2025; 25:77. [PMID: 39948444 PMCID: PMC11823065 DOI: 10.1186/s12876-025-03669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 02/06/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Needle knives are the most commonly used instrument during endoscopic treatment for gastric submucosal tumors (SMTs). The conventional resection method involves fully extending the needle-shaped knife head, which allows it to more easily penetrate the muscularis propria while stripping the muscle layer of the tumor. We propose a semi-blunt dissection method that can effectively reduce damage to the muscularis propria. METHODS A total of 113 patients who underwent endoscopic resection of gastric SMTs originating from the muscularis propria were retrospectively analyzed. The conventional method consisted of 73 patients; The other group consisted of 40 patients underwent the semi-blunt dissection method. RESULTS There was no significant difference between the two groups in age, sex, or lesion location. The intraoperative operational variable, the maximum diameter of gastric muscularis propria damage, was significantly greater in conventional method group than the other group (1.06 ± 0.48 cm vs. 0.46 ± 0.09 cm, p < 0.001). There was also no significant difference between the two groups in terms of histological diagnosis, postoperative complications and the percentage of histologically positive resection margins. CONCLUSION The semi-blunt dissection method has certain advantages in the endoscopic resection of gastric tumors originating from the muscularis propria, including a small extent of gastric muscularis propria damage and a shorter postoperative hospital stay.
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Affiliation(s)
- Liming Zhang
- Endoscopy Center, Peking University People's Hospital, Beijing, China.
| | - Rui Zhao
- Endoscopy Center, Peking University People's Hospital, Beijing, China
| | - Junxuan Zhang
- Endoscopy Center, Peking University People's Hospital, Beijing, China
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Pasam RT, Thompson CC, Aihara H. Tunneled or pocket creation method versus conventional endoscopic submucosal dissection for gastric lesions: a systematic review and meta-analysis. Gastrointest Endosc 2025; 101:45-53.e7. [PMID: 38964480 DOI: 10.1016/j.gie.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND AND AIMS Tunneled endoscopic submucosal dissection (T-ESD) and pocket creation-method ESD (PCM-ESD) are considered to have technical advantages over conventional ESD (C-ESD). However, data comparing these techniques for ESD of gastric lesions are limited. METHODS PubMed and Cochrane databases were reviewed for relevant studies from their inceptions to October 31, 2023. Studies comparing T-ESD or PCM-ESD (T/PCM-ESD) with C-ESD for gastric lesions were included. The primary outcomes were dissection speed and en-bloc resection. Secondary outcomes were R0 resection, recurrence, perforation, and post-ESD bleeding. A random effects meta-analysis was conducted. RESULTS Eight observational studies (359 patients with T/PCM-ESD, 670 patients with C-ESD) were included. T/PCM-ESD was associated with a significantly faster dissection speed (mean difference, 4.42 mm2/min; 95% confidence interval [CI], 2.05-6.79; I2 = 79%). There were no significant differences between the groups in terms of en-bloc resection (risk ratio [RR], 1.01; 95% CI, 1.00-1.03; I2 = 0%), R0 resection (RR, 1.03; 95% CI, 0.99-1.07; I2 = 0%), and recurrence (RR, 0.73; 95% CI, 0.14-3.84; I2 = 0%). Although T/PCM-ESD was associated with a significantly lower risk of perforation (RR, 0.21; 95% CI, 0.06-0.80; I2 = 0%), post-ESD bleeding rates were not significantly different. CONCLUSIONS T/PCM-ESD facilitates faster and safer gastric ESD than C-ESD, with similar en-bloc resection, R0 resection, and recurrence rates. A future randomized controlled control trial is required.
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Affiliation(s)
- Ravi Teja Pasam
- Department of Hospital Medicine, Wentworth-Douglass Hospital, Dover, New Hampshire, USA
| | - Christopher C Thompson
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Mohapatra S, Esaki M, Fukami N. Advances in Third Space Endoscopy. Gastroenterol Clin North Am 2024; 53:747-771. [PMID: 39489585 DOI: 10.1016/j.gtc.2024.08.020] [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] [Indexed: 11/05/2024]
Abstract
This article offers a detailed overview of recent advancements in third space endoscopy (TSE), highlighting key procedures and their clinical applications and outcomes. Clinical TSE started as a treatment for achalasia and was named peroral endoscopic myotomy (POEM). Outcome data and comparative data of POEM with other treatments were detailed and discussed. This article also explores the indications and outcomes of other TSE procedures, such as G-POEM, Z-POEM, D-POEM, per-rectal endoscopic myotomy, and STER/POET. This article serves as a valuable resource for endoscopists looking to enhance their understanding and stay updated on these advanced TSE procedures.
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Affiliation(s)
- Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Sai Institute of Gastroenterology and Liver Sciences, Plot 145, Ganganagar, Unit-6, Bhubaneswar, Odisha 751030, India. https://twitter.com/Sonmoon20
| | - Mitsuru Esaki
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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Cecinato P, Sinagra E, Laterza L, Pianigiani F, Grande G, Sassatelli R, Barbara G. Endoscopic removal of gastrointestinal lesions by using third space endoscopy techniques. Best Pract Res Clin Gastroenterol 2024; 71:101931. [PMID: 39209418 DOI: 10.1016/j.bpg.2024.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/19/2024] [Accepted: 06/04/2024] [Indexed: 09/04/2024]
Abstract
The concept of submucosal space, or rather the "third space", located between the intact mucosal flap and the muscularis propria layer of the gastrointestinal tract, represents a tunnel that the endoscopist could use to perform interventions in the muscularis propria layer or breech it to enter the mediastinum or the peritoneal cavity without full thickness perforation. The tunnel technique can be used both for the removal of mucosal tumours, called endoscopic submucosal tunnel dissection (ESTD), for the removal of subepithelial tumours (SELs), called submucosal tunnelling endoscopic resection (STER), and for the removal of extra-luminal lesions (for example in the mediastinum or in the rectum), called submucosal tunnelling endoscopic resection for extraluminal tumours (STER-ET). Aim of this updated narrative review, is to summarize the evidences that analyses indications, and outcomes of tunnelling techniques for the treatment of above mentioned lesions.
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Affiliation(s)
- Paolo Cecinato
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto Gemelli-G.Giglio, Cefalù, (Palermo), Italy.
| | - Liboria Laterza
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Federica Pianigiani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Giuseppe Grande
- Gastroenterology and Digestive Endoscopy Unit, Sant'Agostino Estense Hospital, AOU Modena, Italy.
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Giovanni Barbara
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Xu EP, Qi ZP, Li B, Ren Z, Cai MY, Cai SL, Lyv ZT, Chen ZH, Liu JY, Shi Q, Zhong YS. The efficacy of full-thickness endoscopic resection of subepithelial tumors in the gastric cardia. World J Gastrointest Oncol 2023; 15:2111-2119. [PMID: 38173428 PMCID: PMC10758656 DOI: 10.4251/wjgo.v15.i12.2111] [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: 09/10/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/14/2023] Open
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.
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Affiliation(s)
- En-Pan Xu
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhi-Peng Qi
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhong Ren
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Ming-Yan Cai
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhen-Tao Lyv
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhang-Han Chen
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Jing-Yi Liu
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yun-Shi Zhong
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
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Li C, Wang Q, Jiang KW, Ye YJ. Hallmarks and novel insights for gastrointestinal stromal tumors: A bibliometric analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107079. [PMID: 37826966 DOI: 10.1016/j.ejso.2023.107079] [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: 08/13/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Due to the increasing recognition of gastrointestinal stromal tumor (GIST), novel insights have appeared in both preclinical and clinical research and begun to reshape the field. This study aims to map the research landscape through bibliometric analysis and provide a brief overview for the future of the GIST field. METHODS We searched the Web of Science Core Collection without publication data restrictions for GISTs and performed a bibliometric analysis with CiteSpace and VOSviewer software. RESULTS In sum, 5,911 of 13,776 records were included, and these studies were published in 948 journals and written by 24,965 authors from 4,633 institutions in 100 countries. Referring to published reviews and bibliometric analysis, we classified the future trends in four groups. In epidemiological study, precise incidence and clinicopathological features in different regions and races might become potential hotspots. Novel therapy, such as drugs, modified strategies, radioligand therapy, was persistent hotspots in GIST fields, and ctDNA-guided diagnosis, monitoring, and treatment might meet future clinical needs. The debate over serosa surgery vs. mucosa surgery will remain active for a long time in GIST surgery, and function reserve surgery, biology-based surgery will play an important role in future. Moreover, rare GIST type, like NF-1-associated GIST, Carney triads and SDH mutant GIST, need more studies in pathogenesis and genetic mutation to provide appropriate treatment for this orphan GIST patients. CONCLUSIONS Potential hotspots in future GIST trends might involve epidemiology, agents, resection therapy and rare type GIST, moreover, researchers could pay more attention in these four fields.
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Affiliation(s)
- Chen Li
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, China
| | - Quan Wang
- Ambulatory Surgery Center, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, China
| | - Ke-Wei Jiang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, China.
| | - Ying-Jiang Ye
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, China.
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Tun KM, Dhindsa BS, Dossaji Z, Deliwala SS, Narra G, Haque L, Lo CH, Dhaliwal A, Chandan S, Ramai D, Singh S, Adler DG. Efficacy and safety of submucosal tunneling endoscopic resection for subepithelial tumors in the upper GI tract: a systematic review and meta-analysis of >2900 patients. IGIE 2023; 2:529-537.e2. [DOI: 10.1016/j.igie.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
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Park EY, Baek DH, Hong SM, Lee BE, Lee MW, Kim GH, Song GA. Feasibility of endoscopic resection and impact of endoscopic ultrasound-based surveillance on colorectal subepithelial tumors. Surg Endosc 2023; 37:6867-6876. [PMID: 37311889 DOI: 10.1007/s00464-023-10195-7] [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: 02/12/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Owing to the rising number of screening endoscopies and instrumental advances in endoscopic ultrasound (EUS), colorectal subepithelial tumors (SETs) are being increasingly detected. We aimed to determine the feasibility of endoscopic resection (ER) and the impact of EUS-based surveillance on colorectal SETs. METHODS The medical records of 984 patients with incidentally detected colorectal SETs between 2010 and 2019 were retrospectively reviewed. Overall, 577 colorectal SETs underwent ER, and 71 colorectal SETs underwent serial colonoscopy for > 12 months. RESULTS The mean tumor size (± standard deviation) of 577 colorectal SETs for which ER was performed was 7.0 ± 5.7 (median, 55; range, 1-50) mm; 475 tumors were located in the rectum and 102, in the colon. En bloc resection was achieved in 560/577 treated lesions (97.1%), and complete resection was achieved in 516/577 (89.4%). ER-related adverse events occurred in 15/577 (2.6%) patients. SETs originating from the muscularis propria showed a higher risk of ER-related adverse events and perforation than SETs arising from the mucosal or submucosal layer (odds ratio [OR] 19.786, 95% confidence interval [CI] 4.556-85.919; P = 0.002 and OR 141.250, 95% CI 11.596-1720.492; P = 0.046, respectively). Seventy-one patients were followed up after EUS without any treatment for > 12 months, during which three showed progression; eight, regression; and sixty, no changes. CONCLUSIONS ER for colorectal SETs showed excellent efficacy and safety. Additionally, colorectal SETs without high-risk features in surveillance with colonoscopy showed an excellent prognosis.
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Affiliation(s)
- Eun Young Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
- Department of Internal Medicine, Dong-Eui Medical Center, Busan, South Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea.
| | - Seung Min Hong
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
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Ni M, Tang D, Ren W, Meng R, Yang J, Yan P, Ding X, Xu G, Lv Y, Chen M, Yang H, Wang L. Risk factors of perforation in gastric stromal tumors during endoscopic resection: a retrospective case-control study. Gastric Cancer 2023; 26:590-603. [PMID: 37061602 DOI: 10.1007/s10120-023-01391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND AIMS Perforation is a common complication during endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) associated with secondary infections, sepsis, hospitalization time and cost. However, the risk factors of perforation remain controversial. This study aimed to investigate the risk factors for perforation during ER of gGISTs. METHODS This retrospective case-control study included consecutive patients with gGISTs who underwent ER between June 2009 and November 2021 at the Nanjing Drum Tower Hospital. Univariate and multivariate analyses were performed to investigate the risk factors for perforation. Sensitivity analyses with propensity scoring (PS) were performed to evaluate the stability of the independent effects. RESULTS In total, 422 patients with gGISTs were included. The following factors were associated with perforation during ER: in the non-intraluminal growth patterns (all confounders adjusted odds ratio [aOR]: 5.39, 95% CI 2.99-9.72, P < 0.001), in the gastric fundus (aOR 2.25, 95% CI 1.40-3.60, P = 0.007), sized ≥ 2 cm (aOR 1.70, 95% CI 1.04-2.77, P = 0.035), in the lesser curvature (aOR 0.12, 95% CI 0.05-0.27, P < 0.001), and in the gastric cardia (aOR 0.13, 95% CI 0.04-0.50, P = 0.003). The PS analysis confirmed the stable independent effects of these identified risk factors. CONCLUSIONS ERs of gGISTs in non-intraluminal growth patterns, in the gastric fundus, and with larger tumor size were independent risk factors for perforation. While tumors in the lesser curvature or gastric cardia were independent protective factor for perforation.
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Affiliation(s)
- Muhan Ni
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Dehua Tang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Wei Ren
- Department of Geriatric Medicine, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Rui Meng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jinping Yang
- Oncology Department of Integrated Chinese and Western Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Peng Yan
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Xiwei Ding
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Guifang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Ying Lv
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Min Chen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Hua Yang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
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Chiu PWY, Yip HC, Chan SM, Ng SKK, Teoh AYB, Ng EKW. Endoscopic full-thickness resection (EFTR) compared to submucosal tunnel endoscopic resection (STER) for treatment of gastric gastrointestinal stromal tumors. Endosc Int Open 2023; 11:E179-E186. [PMID: 36845271 PMCID: PMC9949978 DOI: 10.1055/a-1972-3409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background and study aims Submucosal tunnel endoscopic resection (STER) is being increasingly performed for treatment of gastric gastrointestinal stromal tumor (GIST), while STER has been limited by close dissection within tunnel and risking breach of tumor capsule. Endoscopic full-thickness resection (EFTR) allows resection of GIST with margins to prevent recurrence. This study aimed to compare EFTR against STER for treatment of gastric GIST. Patients and methods We retrospectively reviewed clinical outcomes of patients with gastric GIST who received either STER or EFTR. Patients with gastric GISTs < than 4 cm were included. Clinical outcomes including baseline demographics, perioperative and oncological outcomes were compared between the two groups. Results From 2013 to 2019, 46 patients with gastric GISTs were treated with endoscopic resection, 26 received EFTR and 20 received STER. Most of the GISTs were in the proximal stomach. There was no difference in operative time (94.9 vs 84.9 mins; P = 0.401), while endoscopic suturing was applied more for closure after EFTR ( P < 0.0001). Patients after STER had earlier resumption of diet and shorter hospital stay while there was no difference in adverse event rate between two groups. The en-bloc resection rate for EFTR was significantly higher than for STER (100 % vs 80 %; P = 0.029), while there was no difference in the local recurrence. Conclusions This study demonstrated that although patients who received EFTR had longer hospital stays and slower resumption of diet compared to those who underwent STER, EFTR achieved a significantly higher rate of en-bloc resection compared to STER for treatment of gastric GIST.
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Affiliation(s)
- Philip Wai Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Hon Chi Yip
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Shannon Melissa Chan
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Stephen Ka Kei Ng
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Anthony Yuen Bun Teoh
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Enders Kwok Wai Ng
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R, China
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Geng ZH, Zhou PH, Cai MY. Submucosal Tunneling Techniques for Tumor Resection. Gastrointest Endosc Clin N Am 2023; 33:143-154. [PMID: 36375878 DOI: 10.1016/j.giec.2022.07.002] [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] [Indexed: 11/12/2022]
Abstract
The concept of third space endoscopy is based on the principle that the deeper layers of the gastrointestinal tract can be accessed by tunneling in the submucosal space and maintaining the integrity of the overlying mucosa. The mucosal flap safety valve enabled endoscopists to use submucosal space securely. The era of third space endoscopy started with peroral endoscopic myotomy for treatment of achalasia and has expanded to treat various other gastrointestinal disorders, such as mucosal lesions, submucosal tumors, extraluminal tumors, and refractory gastroparesis, Zenker diverticulum, and restoration of the completely obstructed esophageal lumen. Third space endoscopy rapidly emerged as a minimally invasive alternative to conventional surgery. Many studies discovered that this technique is safe and effective with excellent outcomes. Our review focused on the indications, techniques, clinical management, and adverse events of submucosal tunneling techniques for tumor resection.
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Affiliation(s)
- Zi-Han Geng
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
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13
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Maehata T, Sato Y, Nakamoto Y, Kato M, Kawashima A, Kiyokawa H, Yasuda H, Yamamoto H, Tateishi K. Updates in the Field of Submucosal Endoscopy. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010104. [PMID: 36676053 PMCID: PMC9864725 DOI: 10.3390/life13010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
Submucosal endoscopy (third-space endoscopy) can be defined as an endoscopic procedure performed in the submucosal space. This procedure is novel and has been utilized for delivery to the submucosal space in a variety of gastrointestinal diseases, such as a tumor, achalasia, gastroparesis, and subepithelial tumors. The main submucosal endoscopy includes peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, and endoscopic submucosal tunnel dissection. Submucosal endoscopy has been used as a viable alternative to surgical techniques because it is minimally invasive in the treatment and diagnosis of gastrointestinal diseases and disorders. However, there is limited evidence to prove this. This article reviews the current applications and evidence regarding submucosal endoscopy while exploring the possible future clinical applications in this field. As our understanding of these procedures improves, the future of submucosal endoscopy could be promising in the fields of diagnostic and therapeutic endoscopy.
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14
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Zhao F, Liu Z, Wei A, Wang W, Xu N, Pu X. Efficacy and feasibility of snare-assisted endoscopic resection of small submucosal gastric tumors: A retrospective analysis. Front Oncol 2022; 12:1068183. [DOI: 10.3389/fonc.2022.1068183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background and aimThe prevalence of small submucosal gastric tumors is rising. Despite the fact that high success rate of endoscopic resection of small submucosal gastric tumors originating from the muscularis propria has been reported, the procedure is technically challenging and has a high rate of complications. In this study, we investigated the efficacy and feasibility of a novel snare-assisted endoscopic resection technique for small submucosal gastric tumors.Patients and methodsThis is a single-center consecutive study of 50 patients who were diagnosed with small submucosal gastric tumors originating from the muscularis propria and who subsequently underwent snare-assisted endoscopic resection between January 2019 and January 2021 at our hospital. Data on the demographic characteristics, procedural success rate, complications, recurrence rate, and histopathology of the resected specimen were collected and analyzed retrospectively.ResultsThe majority of the patient’s population was male (66%) with the mean age of 48.4 ± 9 years (range, 20–70 years). The mean size of the tumor confirmed by endoscopic ultrasonography was 6.4 ± 1.6 mm (range, 3.1–9.8 mm). All the tumors were resected successfully using snare-assisted endoscopic resection technique. The mean procedure time was 22.8 ± 9.6 (range, 15–35 min). The technical (performed the procedure successfully without converting to surgery) and clinical (the patient fully recovered after the procedure without experiencing any complications) success rate of the procedure was 100%. Eighteen (24%) patients had very small amount of mucosal damage, and wound closure was not needed in these patients. During 6–24 months of follow-up, no recurrence or metastasis occurred. No adverse event was noted during the follow-up time.ConclusionThe novel approach of snare-assisted endoscopic resection is simple, feasible, and effective for tumors with small size and originating from the gastric muscularis propria. In addition, it offers a better alternative therapy for the complete resection of small submucosal gastric tumors. Its advantages compared with traditional endoscopic approaches such as endoscopic submucosal resection and endoscopic submucosal dissection include shorter procedure times, lesser cost, and a lower rate of complications (perforation, bleeding, and infection).
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15
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Yang W, Zhang J, Wang C, Chen Y, Ma W, Wu W. Enucleation of Esophageal Leiomyoma Less Than 3 cm: Submucosal Tunneling Endoscopic Resection Versus Thoracoscopic Resection. J Gastrointest Surg 2022; 27:777-779. [PMID: 36422839 DOI: 10.1007/s11605-022-05518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/24/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Wei Yang
- Department of Gastroenterology, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Jinshun Zhang
- Health Management Center, Taizhou Hospital, Zhejiang Province, Linhai, China.
| | - Chunguo Wang
- Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Yahong Chen
- Health Management Center, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Weiwei Ma
- Endoscopic Center, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Weidan Wu
- Department of Gastroenterology, Taizhou Hospital, Zhejiang Province, Linhai, China
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16
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Yang B, Han H, Shen J, Lu P, Jiang F. Endoscopic resection of large subepithelial esophageal lesions via submucosal tunneling endoscopic resection and endoscopic submucosal dissection: a single-center, retrospective cohort study. Scand J Gastroenterol 2022; 57:633-641. [PMID: 35049422 DOI: 10.1080/00365521.2022.2028003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to compare the clinical outcomes between submucosal tunneling endoscopic resection (STER) and endoscopic submucosal dissection (ESD) for large subepithelial esophageal lesions (SELs) and analyze risk factors for perforation and piecemeal resection. METHODS The clinicopathological features and outcomes of endoscopic treatment of 56 patients with SELs with diameters ≥30 mm, diagnosed between June 2017 and December 2020, were reviewed in this retrospective cohort study. Patients were divided into two groups (ESD group and STER group). RESULTS The complete resection rates of the STER and ESD groups were 88.1% and 78.6%, respectively (p = .398). The operation time of STER was longer than ESD (p = .03), while the hospital stay of STER was shorter than ESD (p = .02). The rate of major adverse events associated with ESD was considerably higher than STER group (p = .035). The extraluminal growth pattern was a risk factor for piecemeal resection, and ESD was an independent risk factor for perforation. Regarding tumors with extraluminal growth patterns, the ESD group's perforation rate was significantly higher than the STER group (p = .009). There were no recurrence or metastases found during a mean follow-up of 24.4 months. CONCLUSION The STER technique has advantages of shorter hospital stays and fewer major adverse events than ESD. The extraluminal growth pattern seems to be a risk factor for piecemeal resection in both ESD and STER. STER appears to be a preferable choice for large SELs with extraluminal growth patterns.
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Affiliation(s)
- Bin Yang
- Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China
| | - Huazhong Han
- Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China
| | - Jianhong Shen
- Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China
| | - Pinxiang Lu
- Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China
| | - Fei Jiang
- Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China
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Dalal I, Andalib I. Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER). Transl Gastroenterol Hepatol 2022; 7:19. [PMID: 35548477 PMCID: PMC9081920 DOI: 10.21037/tgh-2020-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023] Open
Abstract
Subepithelial lesions are often detected incidentally in patients undergoing an endoscopy. They are common tumors of the gastrointestinal (GI) tract which can originate from different layers of the GI tract wall. These lesions can be further classified based on GI layer of origin and unique histochemical staining. While most are benign and asymptomatic, some of these lesions have malignant potential with distant metastases. However, current diagnostic modalities including endoscopy with biopsy or endoscopic ultrasound with fine needle aspiration are not always reliable. In addition, management of these lesions has historically involved surgical resection via open or laparoscopic approaches. In recent years, with advancement in endoscopic techniques and improvement in endoscopists' skills, less invasive procedures such as endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) have been developed and now are being used by endoscopists worldwide. Upon reviewing the literature, multiple studies have shown the advantages of these endoscopic techniques when compared with surgical treatment. As a result, there has been a dramatic shift towards minimally invasive endoscopic procedures for the management of these subepithelial lesions. In this review article, we will discuss these endoscopic resection techniques in detail, their safety and efficacy, as well as comparison studies to other therapeutic modalities.
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Affiliation(s)
- Ishita Dalal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA
| | - Iman Andalib
- Department of Gastroenterology and Hepatology, Mount Sinai South Nassau, Oceanside, New York, USA
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18
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Geng ZH, Zhu Y, Chen WF, Chen SY, Zhong YS, Zhang YQ, Ma LL, Qin WZ, Hu JW, Cai MY, Yao LQ, Li QL, Zhou PH. A scoring system to support surgical decision-making for cardial submucosal tumors. Endosc Int Open 2022; 10:E468-E478. [PMID: 35433224 PMCID: PMC9010105 DOI: 10.1055/a-1775-7976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background and study aims Submucosal tunneling endoscopic resection (STER) and non-tunneling techniques are two alternative options for the treatment of cardial submucosal tumors (SMTs). We aimed to establish a regression model and develop a simple scoring system (Zhongshan Tunnel Score) to help clinicians make surgical decisions for cardial submucosal tumors. Patients and methods A total of 246 patients who suffered cardial SMTs and received endoscopic resection were included in this study. All of them were randomized into either the training cohort (n = 147) or the internal validation cohort (n = 99). Then, the scoring system was proposed based on multivariate logistic regression analysis in the training cohort and assessed in the validation cohort. Results Of 246 patients, 97 were treated with STER and the others with non-tunneling endoscopic resection. In the training stage, four factors were weighted with points based on the β coefficient from the regression model, including irregular morphology (-2 points), ulcer (2 points), the direction of the gastroscope (-2 points for forward direction and 1 point for reverse direction), and originating from the muscularis propria (-2 points). The patients were categorized into low-score (< -4), medium-score (-4 to -3) and high-score (> -3) groups, and those with low scores were more likely to be treated with STER. Our score model performed satisfying discriminatory power in internal validation (Area under the receiver-operator characteristic curve, 0.829; 95 % confidence interval, 0.694-0.964) and goodness-of-fit in the Hosmer-Lemeshow test ( P = .4721). Conclusions This scoring system could provide clinicians the references for making decisions about the treatment of cardial submucosal tumors.
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Affiliation(s)
- Zi-Han Geng
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Zhu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shi-Yao Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun-Shi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Li Ma
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Zheng Qin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Wei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Qing Yao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
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The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics (Basel) 2022; 12:diagnostics12040810. [PMID: 35453857 PMCID: PMC9027519 DOI: 10.3390/diagnostics12040810] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period.
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Ponte Neto FL, de Moura DTH, Sagae VMT, Ribeiro IB, Mancini FC, Boghossian MB, McCarty TR, Miyajima NT, Ide E, Bernardo WM, de Moura EGH. Endoscopic resection of esophageal and gastric submucosal tumors from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation: A systematic review and meta-analysis. Surg Endosc 2021; 35:6413-6426. [PMID: 34415431 DOI: 10.1007/s00464-021-08659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) are less-invasive therapeutic alternatives to surgical resection for the removal of esophageal or gastric submucosal tumors (SMTs). This study aimed to comparing STER versus ESE for the resection of esophageal and gastric SMTs from the muscularis propria. METHODS This systematic review and meta-analysis was reported in accordance with PRISMA guidelines through December 2020. Pooled outcome measures included complete resection, en bloc resection, bleeding, perforation, adverse events, recurrence, procedure duration, and length of hospital stay. Risk ratio (RR) and mean difference (MD) was calculated as well as Peto time-to-event analyses to determine recurrence rate. RESULTS Five retrospective cohort studies (n = 269 STER versus n = 319 ESE) were included. There was no difference in rates of complete resection [RR: 1.01 (95% CI 0.94, 1.07)], en bloc resection [RR: 0.95 (95% CI 0.84, 1.08)], recurrence [OR: 1.18 (95% CI 0.33, 4.16)], and total adverse events [RR: 1.33 (95% CI 0.78, 2.27)]. Specific adverse events including rates of perforation [RR: 0.57 (95% CI 0.12, 2.74)] and bleeding [RR: 1.21 (95% CI 0.30, 4.88)] were not different between STER and ESE. There was a statistical difference when evaluating procedure time, with the STER group presenting significantly larger values [MD: 24.62 min (95% CI 20.04, 29.20)]. CONCLUSION STER and ESE were associated with similar efficacy and safety; however, ESE was associated with a significantly decreased time to complete the procedure.
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Affiliation(s)
- Fernando Lopes Ponte Neto
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vitor Massaro Takamatsu Sagae
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Igor Braga Ribeiro
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Fabio Catache Mancini
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mateus Bond Boghossian
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thomas R McCarty
- Division of Gasteoenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Nelson Tomio Miyajima
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Edson Ide
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Wanderley Marques Bernardo
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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21
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Joo MK. Endoscopic Resection of Gastrointestinal Stromal Tumor: Is It Safe? THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2021.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, results from clinical studies of endoscopic resection of gastrointestinal stromal tumor (GIST) in the stomach are being reported. This procedure has several advantages, such as the provision of a definite diagnosis and therapeutic plan, avoidance of frequent follow-up examination, and reduction of patients’ anxiety. However, several concerns also exist such as a limited number of studies, low R0 resection rate, and relatively shorter follow-up period compared with surgical resection. Nevertheless, it is encouraging that most of the post-procedural complications have been treated with conservative management and that some of the patients did not show recurrence of the tumor during long-term follow-up. The selection of suitable cases and the experience of the endoscopists are the most important factors for successful endoscopic resection of gastric GIST. Development of novel procedures as well as collaboration with laparoscopic surgeons are currently in progress.
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22
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Liu J, Wang Y, Liu Z, Lv L, Ren Z, Hu J, Qin W, Zhong Y, Zhou P, Li Q. Submucosal tunneling endoscopic resection treatment of multiple gastrointestinal submucosal tumors. J Gastroenterol Hepatol 2021; 36:2575-2580. [PMID: 33914364 DOI: 10.1111/jgh.15532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/17/2021] [Accepted: 04/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Gastrointestinal submucosal tumors (SMTs) can be removed by submucosal tunneling endoscopic resection (STER). However, limited studies have evaluated STER for the removal of multiple upper gastrointestinal SMTs. The aim of this study was to evaluate the feasibility and outcomes of STER in the treatment of multiple upper gastrointestinal SMTs. METHODS From January 2011 to April 2020, the cases of patients with multiple upper gastrointestinal SMTs undergoing STER were retrospectively analyzed. Variables of clinicopathological characteristics, major adverse events (mAEs), and follow up were collected and analyzed. RESULTS Submucosal tunneling endoscopic resection was performed in 54 patients (48 male and 6 female patients) with 120 SMTs. Forty-four patients had two tumors, eight patients had three tumors, and two patients had four tumors. The median size of each patient was 1.8 cm (range 0.7 to 3.5 cm). Forty-five patients had tumors removed by one tunnel, and nine patients by two tunnels. The median procedure time was 50 min (range 14 to 120 min), and the mAE rate was 16.7% (9/54). No significant differences were found between patients with two tumors and those with > 2 tumors in terms of tunnel length, hospital stay, procedure time, and mAEs (all P > 0.05). In addition, patients with two tunnels had procedure time, hospital stay, and mAE rates comparable with those with one tunnel (all P > 0.05). No local recurrence or distant metastasis occurred during a median follow up of 64 months. CONCLUSIONS Submucosal tunneling endoscopic resection is a safe and effective technique for the resection of multiple upper gastrointestinal SMTs.
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Affiliation(s)
- Jingzheng Liu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Wang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zuqiang Liu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Lv
- Qingdao Chengyang People's Hospital, Qingdao, China
| | - Zhong Ren
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianwei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenzheng Qin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunshi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quanlin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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23
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A Review of Endoscopic Full-thickness Resection, Submucosal Tunneling Endoscopic Resection, and Endoscopic Submucosal Dissection for Resection of Subepithelial Lesions. J Clin Gastroenterol 2021; 55:309-315. [PMID: 33606429 DOI: 10.1097/mcg.0000000000001500] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gastrointestinal subepithelial tumors (SETs) are often found while performing routine endoscopy. Recently, there has been the development of new endoscopic techniques such as endoscopic submucosal dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection, all minimally invasive approaches which have made it possible to resect SETs that were previously resected with surgery. This review discusses the endoscopic treatment of patients with SETs, outcomes for endoscopic treatment, procedure-related complications, and advantages and disadvantages of these endoscopic techniques.
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Zhang Y, Peng JB, Mao XL, Zheng HH, Zhou SK, Zhu LH, Ye LP. Endoscopic resection of large (≥ 4 cm) upper gastrointestinal subepithelial tumors originating from the muscularis propria layer: a single-center study of 101 cases (with video). Surg Endosc 2021; 35:1442-1452. [PMID: 32989549 DOI: 10.1007/s00464-020-08033-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Although endoscopic resection (ER) is already established as a minimally invasive technique for small (< 4.0 cm) upper gastrointestinal subepithelial tumors originating from the muscularis propria layer (MP-SETs), published data of ER for large (≥ 4.0 cm) upper gastrointestinal MP-SETs are extremely rare and limited to case reports. This retrospective study aimed to evaluate the feasibility and safety of ER for large (≥ 4.0 cm) upper gastrointestinal MP-SETs in a large case series. METHODS Between June 2012 and December 2018, 101 patients with large (≥ 4 cm) upper gastrointestinal MP-SETs were enrolled in this study. The main outcome measures included complete resection, total complications, and local residual or recurrent tumor. RESULTS The rate of complete resection was 86.1%. Thirteen patients (12.9%) experienced complications including gas-related complications (6/101, 5.9%), localized peritonitis (4/101, 4.0%), esophageal/cardiac mucosal laceration (2/101, 2.0%), and delayed bleeding (1/101, 1.0%). These 13 patients recovered after endoscopic and conservative treatment. The independent risk factor for incomplete resection was tumor size (P = 0.005), and the independent risk factors for total complications were tumor size (P = 0.011) and tumor extraluminal growth (P = 0.037). During the median follow-up of 36 months, local residual tumor was detected in 1 patient. No local recurrence occurred in any patient. CONCLUSIONS Despite being associated with a relatively low complete resection rate, ER is an alternative therapeutic method for large (≥ 4.0 cm) upper gastrointestinal MP-SETs when performed by an experienced endoscopist. This method is especially valuable for patients who are unwilling to undergo surgery.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China
| | - Jin-Bang Peng
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, Zhejiang, China
| | - Shen-Kang Zhou
- Department of Gastrointestinal Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, Zhejiang, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang, China.
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25
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Liu L, Guo HM, Miao F, Li N, Jiao SH, Cai S, Liu PL, Zhang SS, Ma J, Weng Y, Sun Y, Tang YS, Zhao F, Zheng Y, Zhang S, Yang Y, Zhao ZF. Endoscopic Esophageal Submucosal Tunnel Dissection for Cystic Lesions Originating from the Muscularis Propria of the Gastric Cardia. JOURNAL OF ONCOLOGY 2020; 2020:5259717. [PMID: 32884570 PMCID: PMC7455822 DOI: 10.1155/2020/5259717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/12/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the types and properties of cystic lesions originating from the muscularis propria of the gastric cardia (CLMPGC), explore the growth pattern and anatomical characteristics, and evaluate the safety, feasibility, and clinical efficacy of endoscopic esophageal submucosal tunnel dissection (ESTD). METHODS From September 2013 to July 2018, we treated 6 patients with CLMPGC whom we had diagnosed using endoscopy, endoscopic ultrasound (EUS), and Computed Tomography (CT) before the operations. ESTD was the best option for treatment for all these patients. Postoperative observation and follow-ups were performed, and the operational, clinical data, and treatment results are analyzed. RESULTS The mean age of the patients was 50.67 ± 11.59 years (male : female = 1 : 1). The only clinical manifestations the patients exhibited were upper abdominal discomfort. The diameter of the masses was 2.05 ± 0.73 (1.1-3.0) cm. The duration of the ESTD operation was 93.5 (82-256) mins, and the length of hospital stay was 7.50 ± 1.38 days. Postoperative pathology showed 4 cases of an epithelioid cyst, and 2 cases of mucocele with xanthogranuloma. There were no complications, such as hemorrhage, pneumothorax, and pleural effusion during and after the operation. No recurrence during the follow-ups was observed. CONCLUSION The CLMPGC were mainly mucocele and epidermoid cyst, in an expansive growth pattern, and these lesions had no distinct borders with the muscularis propria. The muscularis propria formed a complete wall of the lesion. There was no direct blood supply to the lesions from big blood vessels. Endoscopic esophageal submucosal tunnel dissection was a safe, feasible, and effective treatment for CLMPGC.
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Affiliation(s)
- Lu Liu
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Hai-Mei Guo
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Feng Miao
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Nuo Li
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Shu-Hua Jiao
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Shuang Cai
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Peng-Liang Liu
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Shan-Shan Zhang
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Jia Ma
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Yang Weng
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Ying Sun
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Yin-Si Tang
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Feng Zhao
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Yan Zheng
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Shen Zhang
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Yan Yang
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Zhi-Feng Zhao
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
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Ahmed M. Recent advances in the management of gastrointestinal stromal tumor. World J Clin Cases 2020; 8:3142-3155. [PMID: 32874969 PMCID: PMC7441252 DOI: 10.12998/wjcc.v8.i15.3142] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/26/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) is a rare but an important clinical entity seen in our clinical practice. It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine. Although the exact prevalence of GIST is not known, the incidence of GIST has been increasing. GISTs arise from interstitial cells of Cajal. Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene. 15% of GISTs do not have these mutations and they are called wild-type GISTs. Almost all GISTs express KIT receptor tyrosine kinase. Histologically, GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type. The median size of GISTs varies from 2.7 cm to 8.9 cm. Clinically, patients with small GISTs remain asymptomatic but as the GIST size increases, patients present with various symptoms depending on the location of the GIST. Most of GISTs are located in the stomach or small bowel. Diagnosis is suspected on imaging and endoscopic studies, and confirmed by tissue acquisition with immunohistochemical staining. The aggressiveness of GISTs depends on the size, mitotic index and location. Surgical resection is the treatment of choice. But various endoscopic modalities of resection are increasingly being tried. Tyrosine kinase inhibitors are extremely useful in the management of large GISTs, unresectable GISTs and metastatic GISTs. Treatment options for metastatic GISTs also include radiotherapy, chemotherapy, hepatic artery embolization, chemoembolization and radiofrequency ablation.
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Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
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27
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Businello G, Dal Pozzo CA, Sbaraglia M, Mastracci L, Milione M, Saragoni L, Grillo F, Parente P, Remo A, Bellan E, Cappellesso R, Pennelli G, Michelotto M, Fassan M. Histopathological landscape of rare oesophageal neoplasms. World J Gastroenterol 2020; 26:3865-3888. [PMID: 32774063 PMCID: PMC7385561 DOI: 10.3748/wjg.v26.i27.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
The landscape of neoplastic pathology of the oesophagus is dominated by malignancies of epithelial origin, in particular by oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. However, several other histopathological variants can be distinguished, some associated with peculiar histopathological profiles and prognostic behaviours and frequently underrecognized in clinical practice. The aim of this review is to provide a comprehensive characterization of the main morphological and clinical features of these rare variants of oesophageal neoplastic lesions.
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Affiliation(s)
- Gianluca Businello
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Carlo Alberto Dal Pozzo
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Marta Sbaraglia
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Luca Mastracci
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, First Pathology Division, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Federica Grillo
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Italy
| | - Andrea Remo
- Department of Pathology, Ospedale Mater Salutis di Legnago, Legnago 37045, Italy
| | - Elena Bellan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Rocco Cappellesso
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Gianmaria Pennelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Mauro Michelotto
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
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28
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Bajaj JS, Brenner DM, Cai Q, Cash BD, Crowell M, DiBaise J, Gallegos-Orozco JF, Gardner TB, Gyawali CP, Ha C, Holtmann G, Jamil LH, Kaplan GG, Karsan HA, Kinoshita Y, Lebwohl B, Leontiadis GI, Lichtenstein GR, Longstreth GF, Muthusamy VR, Oxentenko AS, Pimentel M, Pisegna JR, Rubenstein JH, Russo MW, Saini SD, Samadder NJ, Shaukat A, Simren M, Stevens T, Valdovinos M, Vargas H, Spiegel B, Lacy BE. Major Trends in Gastroenterology and Hepatology Between 2010 and 2019: An Overview of Advances From the Past Decade Selected by the Editorial Board of The American Journal of Gastroenterology. Am J Gastroenterol 2020; 115:1007-1018. [PMID: 32618649 DOI: 10.14309/ajg.0000000000000709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J S Bajaj
- Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - D M Brenner
- Northwestern University, Chicago Illinois, USA
| | - Q Cai
- Emory University, Atlanta, Georgia, USA
| | - B D Cash
- McGovern Medical School, Houston, Texas, USA
| | - M Crowell
- Mayo Clinic, Scottsdale, Arizona, USA
| | - J DiBaise
- Mayo Clinic, Scottsdale, Arizona, USA
| | | | - T B Gardner
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Ha
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - G Holtmann
- University of Queensland, Brisbane, Australia, USA
| | - L H Jamil
- Beaumont Health-Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - G G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - H A Karsan
- Atlanta Gastroenterology Associates and Emory University, Atlanta, Georgia, USA
| | - Y Kinoshita
- Steel Memorial Hirohata Hospital and Himeji Brain and Heart Center, Himeji, Japan
| | - B Lebwohl
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - G F Longstreth
- Kaiser Permanente Southern California, San Diego, California, USA
| | - V R Muthusamy
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - M Pimentel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - J R Pisegna
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA Los Angeles, California, USA
| | - J H Rubenstein
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - M W Russo
- Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA
| | - S D Saini
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - A Shaukat
- Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - M Simren
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - T Stevens
- Cleveland Clinic, Cleveland, Ohio, USA
| | - M Valdovinos
- Instituto Nacional de Ciencias Médicas y Nutricion S.Z., Mexico City, Mexico
| | - H Vargas
- Mayo Clinic, Scottsdale, Arizona, USA
| | - B Spiegel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - B E Lacy
- Mayo Clinic, Jacksonville, Florida, USA
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Marcella C, Sarwar S, Ye H, Shi RH. Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract. Clin Endosc 2020; 53:458-465. [PMID: 32178486 PMCID: PMC7403013 DOI: 10.5946/ce.2019.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/21/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinal stromal tumors (GISTs). However, the efficacy of ET remains debatable. In this study, we evaluated the efficacy and safety of ET for GISTs in the upper gastrointestinal tract. METHODS This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 to July 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, and follow-up were investigated and analyzed. RESULTS Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the fundus with a mean tumor size of 2.1±1.43 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.29 years, 64.7±35.23 minutes, 6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and 3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence or metastasis. CONCLUSION ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment of choice for patients with no metastasis.
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Affiliation(s)
- Cicilia Marcella
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Shakeel Sarwar
- Department of Orthopedics, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Hui Ye
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Rui Hua Shi
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
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30
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Liu AQ, Chiu PWY. Third space endoscopy: Current evidence and future development. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020; 9:42-52. [DOI: 10.18528/ijgii200007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/04/2025] Open
Affiliation(s)
- Alex Qinyang Liu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Wai Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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31
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Zhou Y, Zheng S, Sun M, Li Q. Diagnosis and Endoscopic Treatment of Gastrointestinal Stromal Tumors Arising from Esophagus. J Laparoendosc Adv Surg Tech A 2020; 30:759-763. [PMID: 32208040 DOI: 10.1089/lap.2019.0792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: The primary purpose of this study was to investigate the diagnosis and endoscopic treatment of gastrointestinal stromal tumors (GISTs) arising from esophagus. Materials and Methods: From January 2013 to December 2017, 16 cases of GISTs of esophagus were retrospectively identified from a total of >3000 GISTs treated in our center. Demographic characteristics, clinical data, endoscopic therapy outcomes, histopathology, and follow-up were analyzed. Results: The mean age of the patients was 53 years (range 35-71 years), mostly female (56.3%). Seven tumors were in the lower esophagus, five in the middle esophagus, and one in the upper esophagus. The most common symptom was abdominal discomfort (8/16; 50.0%), followed by acid reflux (6/16; 37.5%). All of the patients underwent CT scan, gastroscopy, and/or endoscopic ultrasound. Two patients were diagnosed with esophageal GISTs with a preoperative endoscopic biopsy. Tumors were resected completely in all patients by endoscopic surgery. The median operating time was 85 minutes (range 28-153 minutes), and the average tumor size was 11.6 mm (range 6-21 mm). Postoperative histopathology demonstrated esophageal GISTs were positive for CD117 and CD34. The mean length of postoperative hospital stay was 4.7 days (range 2-7 days). The median postoperative follow-up duration was 28 months (range 1-59 months). Conclusion: Endoscopic treatment seems to be safe and effective for tumors size <20 mm in diameter. However, long-term prospective randomized controlled trials are further needed.
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Affiliation(s)
- Yangyang Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shimeng Zheng
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meiling Sun
- Department of Gastroenterology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing Li
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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32
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Wang GX, Yu G, Xiang YL, Miu YD, Wang HG, Xu MD. Submucosal tunneling endoscopic resection for large symptomatic submucosal tumors of the esophagus: A clinical analysis of 24 cases. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:42-48. [PMID: 32009613 DOI: 10.5152/tjg.2020.19062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIMS Studies evaluating submucosal tunneling endoscopic resection (STER) for the treatment of upper gastrointestinal submucosal tumors (SMTs) have recently increased. However, the efficacy and safety of STER for the treatment of large symptomatic SMTs in the esophagus have not been well investigated. The aim of the present study was to evaluate the efficacy and safety of STER for the treatment of large symptomatic SMTs in the esophagus. METHODS A total of 24 patients with large symptomatic SMTs in the esophagus who underwent STER in our hospitals between January 2015 and May 2018 were included in the study. The tumors were confirmed to be of muscularis propria layer origin. Treatment outcomes, complications, and follow-up results were retrospectively analyzed. RESULTS All 24 lesions were resected en bloc with STER. The mean maximum transverse diameter of the lesions was 4.7 (3.5-6.5) cm. The mean maximum longitudinal diameter of the lesions was 2.1 (1.5-3.0) cm. The mean duration from mucosal incision to complete mucosal closure was 65 (50-115) min. Postoperative pathological diagnosis confirmed 18 cases with leiomyomas, 4 cases with stromal tumors, and 2 cases with schwannomas. There were no major complications. There were no residual lesions or disease recurrence during follow-up. CONCLUSION STER is safe and effective for the treatment of large symptomatic SMTs of muscularis propria layer origin in the esophagus.
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Affiliation(s)
- Guo-Xiang Wang
- Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Guang Yu
- Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Yan-Li Xiang
- Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Yang-De Miu
- Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Hong-Gang Wang
- Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Mei-Dong Xu
- Endoscopy Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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33
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Chen Q, Yu M, Lei Y, Zhong C, Liu Z, Zhou X, Li G, Zhou X, Chen Y. Efficacy and safety of endoscopic submucosal dissection for large gastric stromal tumors. Clin Res Hepatol Gastroenterol 2020; 44:90-100. [PMID: 31852630 DOI: 10.1016/j.clinre.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) of gastric stromal tumors is becoming increasingly common. However, there have been few studies analyzing the therapeutic efficacy and safety of this technique on large (≥ 3 cm) gastric stromal tumors (LGSTs). The aim of this study was to determine the feasibility of ESD for the removal of LGSTs and to investigate the clinical safety and efficacy of ESD for this indication. METHODS A retrospective analysis was carried out on 82 patients with LGSTs who underwent an ESD. Data on therapeutic outcomes and follow-up were collected for an analysis of the rates of en block resection and complete resection. A logistic regression model was used to identify potential risk factors for ESD-related complications, and a receiver operating characteristic (ROC) curve was generated for qualifying independent risk factors. RESULTS En bloc resection was achieved in 81 lesions (98.8%), and complete resection was achieved in 80 lesions (97.6%). The rates of intraoperative and postoperative bleeding were 6.1% and 3.7%, respectively. The accidental perforation rate was 12.2%, the postoperative perforation rate was 3.7%, the intentional perforation rate was 28.0%, and the postoperative infection rate was 12.2%. There was no postoperative mortality. LGSTs originating from the deep muscularis propria (MP) layer (OR = 4.905, 95% CI: 1.362-17.658, P = 0.015), located at the gastric fundus (OR = 4.927, 95% CI:1.308-18.558, P = 0.018) and with an irregular shape (OR = 4.842, 95% CI: 1.242-18.870, P = 0.023) increased the rate of complications. The prediction model that incorporated these factors demonstrated an area under the ROC curve of 0.77 (95% CI: 0.66-0.89). No tumor recurrence or distant metastasis was observed during the follow-up period, which ranged from 6-36 months. CONCLUSIONS ESD is a feasible, safe, effective and minimally invasive approach for the resection of LGSTs. Tumors originating from the deep MP layer, located at the fundus and with an irregular shape were identified as risk factors for the development of complications.
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Affiliation(s)
- Qiaofeng Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Mingju Yu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Yupeng Lei
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Chang Zhong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Zhijian Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Xiaojiang Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Guohua Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Xiaodong Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China.
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China.
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Nabi Z, Ramchandani M, Sayyed M, Darisetty S, Kotla R, Rao GV, Reddy DN. Outcomes of submucosal tunneling endoscopic resection in upper gastrointestinal sub-epithelial tumors. Indian J Gastroenterol 2019; 38:509-517. [PMID: 32002832 DOI: 10.1007/s12664-019-00988-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/30/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Submucosal tunneling techniques have expanded the horizon of therapeutic endoscopy. One such procedure, submucosal tunneling endoscopic resection (STER), enables the endoscopic removal of gastrointestinal (GI) sub-epithelial tumors. In this study, we aimed to evaluate the safety and efficacy of STER in patients with sub-epithelial lesions localized to the upper GI tract. METHODS Consecutive subjects with a sub-epithelial lesion of ≥ 1 cm size in the upper GI tract were enrolled in the study. STER was performed using the standard technique in an endoscopy suite. A modified technique (double-opening STER) was used in cases with difficult en bloc resection of the tumor. Outcome measures included technical success, en bloc resection rates, adverse events, and recurrence. RESULTS A total of 104 patients with sub-epithelial tumors were evaluated for STER. Of them, 44 subjects (mean age 44.68 ± 12.82, 52.3% males) underwent standard STER. Majority (31, 70.4%) of the lesions were located in the esophagus and cardia. Technical success and en bloc removal of the tumor were achieved in 97.7% and 88.4% of cases, respectively. There was no major adverse event. Minor adverse events were recorded in 7 (15.9%) cases. Majority (31, 70.4%) of the tumors originated from muscularis propria, followed by submucosa (8, 18.2%) and muscularis mucosa (5, 11.4%). The most common histological diagnosis was leiomyoma (59.1%) followed by GI stromal tumors (20.4%). At a mean follow up of 12.36 ± 7.63 months, there was no incidence of tumor recurrence in en bloc as well as piecemeal resection groups. CONCLUSION STER is a safe and efficacious procedure for sub-epithelial tumors in the upper GI tract. Novel strategies need to be developed to ensure en bloc removal of large lesions.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India.
| | - Mohan Ramchandani
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Mahiboob Sayyed
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Santosh Darisetty
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Rama Kotla
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Guduru Venkat Rao
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - D Nageshwar Reddy
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
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Clinicopathological Features and Prognosis of Small Gastric Gastrointestinal Stromal Tumors (GISTs). J Gastrointest Surg 2019; 23:2136-2143. [PMID: 31012047 DOI: 10.1007/s11605-018-04070-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the safety of endoscopic surgery, the clinicopathological features, and prognoses of small gastric gastrointestinal stromal tumors (GISTs). METHODS Small gastric GIST patients (diameter: 0.10-2.00 cm) resected endoscopically in Zhongshan Hospital were retrospectively identified and clinicopathological features and outcomes were collected. The relationship between clinicopathological characteristics and tumor recurrence was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal tumor diameter for predicting malignant potential. RESULTS All lesions were completely removed by endoscopy and En bloc resection was 98.5%. The most frequent location was the gastric fundus (60.3%) and the average diameter of all lesions was 1.20 cm (range: 0.10-2.00 cm). Mitoses were calculated as more than 5/50 HPF in 44 (6.8%) patients and nuclear atypia was moderate in 243 (37.5%) patients, severe in 1 (0.2%). Necrosis, mucosal infiltration, and vascular infiltration were detected in 8 (1.2%), 5 (0.7%), and 3 (0.5%) patients, respectively. Tumor size was positively correlated with mitotic index (P < 0.001) and nuclear atypia (P < 0.001). After a median follow-up of 54 months, four patients were confirmed local recurrence. ROC curve analysis identified 1.45 cm as the best cut-off value to predict malignant potential (95% CI: 0·694-0·774). Survival analysis showed that patients with tumor diameters larger than 1.45 cm were associated with more local recurrences after resection (P = 0.011). CONCLUSIONS Endoscopic surgery is feasible and safe for small gastric GISTs, especially those in favorable locations. Small gastric GISTs bear a good prognosis as a whole but those with diameters larger than 1.45 cm should receive more intensive surveillance or undergo endoscopic surgery.
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Zhang Y, Zhang W, Zhang Y. Upper gastrointestinal submucosal lesions: Endoscopic ultrasonographic features and endoscopic curative effects. Shijie Huaren Xiaohua Zazhi 2019; 27:999-1006. [DOI: 10.11569/wcjd.v27.i16.999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Upper gastrointestinal submucosal lesions (SMLs) are common gastrointestinal conditions, and their diagnosis and treatment are very complicated. Therefore, it is especially important to select a reasonable treatment method based on the clinical features of the patients. With the wide use of endoscopic techniques, the efficacy of endoscopic treatment of upper gastrointestinal SMLs has been greatly improved. It is important to improve the clinical diagnosis and treatment efficacy by summarizing clinical experience.
AIM To investigate the endoscopic ultrasonographic features of upper gastrointestinal SMLs and their endoscopic curative effects.
METHODS Three hundred and twenty patients with SMLs treated at Department of Gastroenterology of Affiliated Xiang'an Hospital of Xiamen University from January 2015 to February 2017 were included. All the cases underwent ultrasonic endoscopic examination. The diseased region, disease type, the layer where lesions originated, disease type by location, lesion size, and endoscopic curative effects were analyzed.
RESULTS The lesions of 320 cases were mainly located in the stomach, which accounted for 53.75% of all cases, followed by 39.69% in the esophagus, 4.38% in the duodenum, and 2.19% in the cardia of stomach. The common disease categories of SMLs were leiomyoma, interstitialoma, and heterotopic pancreas. The esophageal lesions mainly originated from the muscularis mucosa layer, followed by the muscularis propria layer; the duodenal lesions mainly originated from the submucosa layer; the lesions of the cardia of the stomach mainly originated from the muscularis mucosa layer and muscularis propria layer; the gastric lesions mainly originated from the muscularis propria layer and submucosal layer. The main types of lesions in the esophagus, the cardia of the stomach, the duodenum, and stomach were leiomyoma, interstitialoma and leiomyoma, interstitialoma and heterotopic pancreas, and interstitialoma and heterotopic pancreas, respectively. The majority of lesions had a size of 3 cm or below. Of all 320 cases, 128 (40.00%) underwent endoscopic treatment, including 56 (43.75%) cases of endoscopic mucosal resection (EMR), 4 (3.13%) cases of submucosal tunnel endoscopic resection (STER), and 68 (53.13%) cases of endoscopic submucosal dissection (ESD). The lesions in the ESD group were mainly located in the stomach, while those in the EMR group and STER group were mainly located in the esophagus; the difference was statistically significant (P < 0.05). The lesions in the ESD group and STER group mainly originated from the muscularis propria layer, while those in the EMR group mainly originated from the muscularis mucosa; the difference was statistically significant (P < 0.05). The size of lesions in the ESD group, EMR group, and STER group was mainly 1-3 cm, < 1 cm, and < 1 cm, respectively, and the difference was statistically significant (P < 0.05). There was no statistical difference in the incidence of perforation, bleeding, or the coincidence rate of ultrasonic endoscopic diagnosis of the source of lesions with the operative diagnosis among the three groups (P > 0.05).
CONCLUSION The most common types of SMLs detected by ultrasonic endoscopy are leiomyoma, interstitialoma, and heterotopic pancreas, and the lesions mainly occur in the stomach, especially in the antrum of the stomach. The lesions mainly originate from the muscularis propria layer, muscularis mucosa layer, and submucosa layer. The size of lesions is mostly 3 cm or below. EMR and ESD are common procedures for the treatment of SML, and different procedures are suitable for patients with different lesion sources and sizes.
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Affiliation(s)
- Yan Zhang
- Department of Gastroenterology, Affiliated Xiang'an Hospital of Xiamen University, Xiamen 361005, Fujian Province, China
| | - Wei Zhang
- Department of General Surgery, Anyang Tumor Hospital, Anyang 455000, Henan Province, China
| | - Ying Zhang
- Department of Gastroenterology, Anyang People's Hospital, Anyang 455002, Henan Province, China
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Aslanian HR, Sethi A, Bhutani MS, Goodman AJ, Krishnan K, Lichtenstein DR, Melson J, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, Maple JT. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2019; 4:343-350. [PMID: 31388606 PMCID: PMC6669323 DOI: 10.1016/j.vgie.2019.03.010] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as "exposed" and "nonexposed." In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.
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Key Words
- EFTR, endoscopic full-thickness resection
- ESD, endoscopic submucosal dissection
- GIST, GI stromal tumor
- NOTES, natural orifice transluminal endoscopic surgery
- OTSC, over-the-scope clip
- POEM, per-oral endoscopic myotomy
- PTFE, polytetrafluoroethylene
- SET, subepithelial tumor
- STER, submucosal tunnel endoscopic resection
- TTS, through-the-scope
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Affiliation(s)
- Harry R Aslanian
- Section of Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center/New York-Presbyterian, New York, New York
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Adam J Goodman
- Division of Gastroenterology and Hepatology, NYU Langone Medical Center, New York University School of Medicine, New York, New York
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - David R Lichtenstein
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Joshua Melson
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | | | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Shelby A Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas
| | - Guru Trikudanathan
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota
| | - Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, New York
| | - Rabindra R Watson
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California
| | - John T Maple
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Pang T, Zhao Y, Fan T, Hu Q, Raymond D, Cao S, Zhang W, Wang Y, Zhang B, Lv Y, Zhang X, Ling T, Zhuge Y, Wang L, Zou X, Huang Q, Xu G. Comparison of Safety and Outcomes between Endoscopic and Surgical Resections of Small (≤ 5 cm) Primary Gastric Gastrointestinal Stromal Tumors. J Cancer 2019; 10:4132-4141. [PMID: 31417658 PMCID: PMC6692613 DOI: 10.7150/jca.29443] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 05/21/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic resection is increasingly performed for gastric gastrointestinal stromal tumors (GIST). However, the safety and outcomes remain elusive. We aimed in this retrospective study to compare operative complications and prognosis between endoscopically and surgically resected small (≤ 5 cm) GIST tumor groups. METHODS In this single-center retrospective study, we compared demographics, clinical outcomes, and the R0 resection rate between the endoscopy (n =268) and surgery (n =141) groups. Only GIST tumors in size of ≤ 5.0 cm were recruited for this comparison study. RESULTS Overall, the mean age of patients was 59.0 years (range: 31.0-83.0). The male-female ratio was 0.68. The most common site of GIST was, in the descending order, the gastric fundus (55%), corpus (27.6%), cardia (10.8%), and antrum (6.6%). Compared with the surgery group, GIST tumors in the endoscopy group were significantly smaller (1.69±0.9 cm, vs. 3.20±1.2 cm in the surgery group; P <0.001) in size; postoperative hospital stay was significantly shorter (4.66±1.5 days, vs. 8.11±5.0; P <0.001); post-resection time to first liquid diet was significantly shorter (1.94±1.1 days, vs. 4.63±2.6; P < 0.001); the incidence of operative and post-operative complications was significantly fewer (p < 0.05), and hospital costs were significantly lower (20115.4±5113.5¥, vs. 43378.4±16795.7¥; P < 0.001). The R0 resection rate was significantly lower in the endoscopy (93.3%) than in the surgery (99.3%) groups (P< 0.01). In the endoscopy group, 176 (65.7%) and 69 (25.7%) patients were found to be at very low and low risk of aggressiveness, respectively, in comparison to 27(19.2%) and 86 (61.0%) patients in the surgery group, respectively (P <0.001). Among 409 cases, 50 (12.2%) were found to be at intermediate or high risk of aggressiveness, 20 of which were treated with adjuvant imatinib therapy and but only 8/20 taking imatinib for 1 to 3 months because of side effects and high costs. No local or distant tumor recurrence was observed over an average of 33.5-month follow-ups. Two patients died of other disease in the surgery group. CONCLUSIONS Endoscopic resection of selected small gastric GISTs (≤ 5cm) was feasible, safe, and associated with better intraoperative results and an equal postoperative course, compared to surgical resection.
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Affiliation(s)
- Taohong Pang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
- Department of Gastroenterology, Affiliated Chaohu Hospital of Anhui Medical University
| | - Yan Zhao
- Department of Geriatric, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Ting Fan
- Department of Gastroenterology, Nanjing Drum Tower Clinical College of Nanjing Medical University
| | - Qingqing Hu
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Dekusaah Raymond
- Department of Gastroenterology, Nanjing Drum Tower Clinical College of Nanjing Medical University
| | - Shouli Cao
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Weijie Zhang
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Yi Wang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Bin Zhang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Ying Lv
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Xiaoqi Zhang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Tingsheng Ling
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Yuzheng Zhuge
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Lei Wang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Xiaoping Zou
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Qin Huang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
- VA Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132, USA
| | - Guifang Xu
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
- Department of Gastroenterology, Nanjing Drum Tower Clinical College of Nanjing Medical University
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Ren Z, Lin SL, Zhou PH, Cai SL, Qi ZP, Li J, Yao LQ. Endoscopic full-thickness resection (EFTR) without laparoscopic assistance for nonampullary duodenal subepithelial lesions: our clinical experience of 32 cases. Surg Endosc 2019; 33:3605-3611. [PMID: 31240477 DOI: 10.1007/s00464-018-06644-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 12/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standard treatment for nonampullary duodenal tumors has not yet been established. In case of tumors originated from the muscularis propria (MP) layer and adherent to the serosa layer, the lesions can not be completely removed by ESD. However, with the development of the endoscopic suture technique, endoscopic full-thickness resection (EFTR) of duodenal subepithelial lesions has become possible. METHODS We retrospectively analyzed 32 patients with nonampullary duodenal subepithelial lesions who underwent EFTR between February 2012 and January 2017. The suturing method, complications that occurred during and after the operations, perioperative management, tumor characteristics, and pathological findings were analyzed in all patients. RESULTS The complete resection rate was 100%; all patients successfully received EFTR except for one patient who required conversion to open surgery. Severe abdominal pain was observed after the operation in one patient who then received laparoscopic exploration, and the possibility of delayed perforation was considered. Another patient showed a decline in blood oxygen saturation (SO2) and was transferred to the intensive care unit (ICU) for further management. Delayed bleeding and fistula were not observed. All patients achieved complete remission. CONCLUSION EFTR is a safe, minimally invasive treatment modality that ensures complete eradication of the duodenal subepithelial lesions.
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Affiliation(s)
- Zhong Ren
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Sheng-Li Lin
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ping-Hong Zhou
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Shi-Lun Cai
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhi-Peng Qi
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jian Li
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Li-Qing Yao
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Dellatore P, Bhagat V, Kahaleh M. Endoscopic full thickness resection versus submucosal tunneling endoscopic resection for removal of submucosal tumors: a review article. Transl Gastroenterol Hepatol 2019; 4:45. [PMID: 31304422 DOI: 10.21037/tgh.2019.05.03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
Submucosal tumors (SMT) are protuberant lesions with intact mucosa that have a wide differential. These lesions may be removed by standard polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgically. However, in lesions that arise from the muscularis propria, full thickness resection is recommended. This can be completed using either endoscopic full thickness resection (EFTR) or submucosal tunneling endoscopic resection (STER). EFTR can be accomplished by completing a full thickness resection followed by defect closure or by securing gastrointestinal wall patency before resection. STER is an option that first creates a mucosal dissection proximal to the lesion to allow a submucosal tunnel to be created. Using this tunnel, the lesion may be resected. When comparing STER to EFTR, there was no significant difference when evaluating tumor size, operation time, rate of complications, or en bloc resection rate. However, suture time, amount of clips used, and overall hospital stay were decreased in STER. With these differences, EFTR may be more efficacious in certain parts of the gastrointestinal tract where a submucosal tunnel is harder to accomplish.
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Affiliation(s)
- Peter Dellatore
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vicky Bhagat
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Zhang X, Modayil R, Criscitelli T, Stavropoulos SN. Endoscopic resection for subepithelial lesions-pure endoscopic full-thickness resection and submucosal tunneling endoscopic resection. Transl Gastroenterol Hepatol 2019; 4:39. [PMID: 31231706 DOI: 10.21037/tgh.2019.05.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic full-thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) are the frontier of therapeutic endoscopic. These two methods rely on the skillset and equipment of endoscopic submucosal dissection (ESD) while going beyond the boundaries of the gastrointestinal lumen. They are both representatives of natural orifice transluminal endoscopic surgery, with STER being a direct off-shoot of peroral endoscopic myotomy (POEM). Both techniques are designed for the removal of gastrointestinal tumors originating from the muscularis propria but tend to be used in different organs and come with respective challenges. In this review we will go over the history, indication, technique and literature of these two techniques.
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Affiliation(s)
- Xiaocen Zhang
- Mount Sinai St. Luke's-West Hospital Center, New York, NY, USA
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Chen H, Li B, Li L, Vachaparambil CT, Lamm V, Chu Y, Xu M, Cai Q. Current Status of Endoscopic Resection of Gastric Subepithelial Tumors. Am J Gastroenterol 2019; 114:718-725. [PMID: 31082838 DOI: 10.14309/ajg.0000000000000196] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Most gastrointestinal (GI) subepithelial tumors (SETs) are identified incidentally during endoscopic examination and are located in the stomach. Some SETs are malignant or have the potential to become malignant. Tumors originating from deeper layers, such as the muscularis propria or serosa, are not easy to diagnose and resect. Current guidelines recommend yearly endoscopic surveillance of SETs smaller than 2 cm. This recommendation may not be cost-effective in managing GI SETs. Endoscopic resection results not only in obtaining sufficient tissue for pathological diagnosis but also in resection and curing the tumor. Many different endoscopic methods for resection of GI SETs have been published in the literature. To avoid confusion, we have divided these methods into standard endoscopic submucosal dissection, modified endoscopic submucosal dissection, submucosal tunneling endoscopic resection, and nonexposed and exposed endoscopic full-thickness resection. These procedures offer less invasive approaches than surgery for resection of GI SETs and may be the most cost-effective in taking care of patients with GI SETs.
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Affiliation(s)
- Huimin Chen
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Baiwen Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianyong Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Gastroenterology, PLA 306th Hospital, Beijing, China
| | - Cicily T Vachaparambil
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vladimir Lamm
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yuan Chu
- Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Meidong Xu
- Endoscopic Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Chen Y, Wang M, Zhao L, Chen H, Liu L, Wang X, Fan Z. The retrospective comparison between submucosal tunneling endoscopic resection and endoscopic submucosal excavation for managing esophageal submucosal tumors originating from the muscularis propria layer. Surg Endosc 2019; 34:417-428. [PMID: 30972622 DOI: 10.1007/s00464-019-06785-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) were recently introduced to cure submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. This study aimed to compare clinical performance and safety of STER and ESE in treating esophageal SMTs originating from the MP layer. METHODS From January 2011 to December 2017, retrospective data collection and follow-up were applied for all STER or ESE cases with esophageal SMTs originating from the MP layer in our endoscopy center, including clinical characteristics, procedure success, efficacy, and adverse events. Subgroup analysis was further done based on tumor size and origin. RESULTS 90 STER and 77 ESE were enrolled in this study. There were no significant difference for patient characteristics, procedure performance, and complications for ESE and STER intervention (P > 0.05). STER was faster than ESE (3.90 mm2/min vs 2.82 mm2/min, P < 0.05). For large tumors (≥ 20 mm), both techniques had the similar performance (P > 0.05), while STER led to the shorter hospitalization (4.0d vs 7.0d, P < 0.05) and lower postoperative complication (16.3% vs 45.5%, P < 0.05). For small tumors (< 20 mm), STER achieved faster operation (STER vs ESE, 2.57 mm2/min vs 1.83 mm2/min, P < 0.05). Regardless of tumor origin, there were no significant difference for both techniques, but STER resulted in short hospitalization for SMTs from the deep MP layer (STER vs ESE, 5.0d vs 7.0d, P < 0.05). During the follow-up, 2 residual and 4 recurrence occurred in the STER group, as well as 1 residual and 2 recurrence in the ESE group. CONCLUSIONS Both STER and ESE were effective for treating esophageal SMTs originating from the MP layer. STER might be better due to its faster operation, less complications, and shorter hospitalization.
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Affiliation(s)
- Yingtong Chen
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Min Wang
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Lili Zhao
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - He Chen
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Li Liu
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang Wang
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Zhining Fan
- Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Peng W, Tan S, Huang S, Ren Y, Li H, Peng Y, Fu X, Tang X. Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors with more than 1-year' follow-up: a systematic review and meta-analysis. Scand J Gastroenterol 2019; 54:397-406. [PMID: 30925071 DOI: 10.1080/00365521.2019.1591500] [Citation(s) in RCA: 23] [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: 01/22/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 02/08/2023]
Abstract
Objectives: Submucosal tunneling endoscopic resection (STER) is a novel therapeutic approach for upper gastrointestinal submucosal tumors (SMTs) especially for tumors originating from the muscularis propria layer. Presently, several studies have reported the efficacy and safety of STER for SMTs. Therefore, we conducted this study to review the clinical outcomes of STER with more than 1-year' follow-up duration. Materials and methods: Medline, Embase and Cochrane databases were searched on November 2018 to identify studies reporting STER for SMTs. Weighted pooled rates were calculated for en bloc resection, complete resection and adverse event (AE). Risk ratios (RR) were calculated and pooled to compare STER with thoracoscopic enucleation (TE). Results: A total of 701 patients with 728 lesions from 12 original studies were review. Pooled WPR for en bloc resection of STER was 86.3% (95% CI: 74.5-93.1%), (I2=82.5). Pooled WPR for complete resection of STER was 97.7% (95% CI: 92.8-99.3%), (I2=77.6). WPR for AE was 18.3% (95% CI: 9.7-31.6%), (I2=90.6%). Two studies with 292 patients compared the performance of STER with TE. Pooled RR for en bloc resection was 1.02 (95% CI: 0.95-1.09). Pooled RR for complete resection was 1.0 (95% CI: 0.98-1.03). Pooled RR for AE was 0.82 (95% CI: 0.33-2.05). Conclusions: Our study showed that STER has relatively long-term efficacy for treating upper gastrointestinal SMTs, and the incidence of AE was not low for STER, but all of them can be managed conservatively.
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Affiliation(s)
- Wei Peng
- a Department of Gastroenterology , Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Shali Tan
- a Department of Gastroenterology , Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Shu Huang
- b Department of Gastroenterology , the People's Hospital of Lianshui , Huaian , China
| | - Yutang Ren
- c Departmemt of Gastroenterology , Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University , Beijing , China
| | - Huan Li
- a Department of Gastroenterology , Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Yan Peng
- a Department of Gastroenterology , Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Xiangsheng Fu
- d Department of Gastroenterology , the Affiliated Hospital of North Sichuan Medical College , Nanchong , China
| | - Xiaowei Tang
- a Department of Gastroenterology , Affiliated Hospital of Southwest Medical University , Luzhou , China
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Chai NL, Li HK, Linghu EQ, Li ZS, Zhang ST, Bao Y, Chen WG, Chiu PWY, Dang T, Gong W, Han ST, Hao JY, He SX, Hu B, Hu B, Huang XJ, Huang YH, Jin ZD, Khashab MA, Lau J, Li P, Li R, Liu DL, Liu HF, Liu J, Liu XG, Liu ZG, Ma YC, Peng GY, Rong L, Sha WH, Sharma P, Sheng JQ, Shi SS, Seo DW, Sun SY, Wang GQ, Wang W, Wu Q, Xu H, Xu MD, Yang AM, Yao F, Yu HG, Zhou PH, Zhang B, Zhang XF, Zhai YQ. Consensus on the digestive endoscopic tunnel technique. World J Gastroenterol 2019; 25:744-776. [PMID: 30809078 PMCID: PMC6385014 DOI: 10.3748/wjg.v25.i7.744] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
With the digestive endoscopic tunnel technique (DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria (MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal (GI) tract. At present, the tunnel technique application range covers the following: (1) Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis; (2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and (3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment. The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism, and significance of DETT, prevention of infection and concepts of DETT-associated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract (indications and contraindications, procedures, pre- and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).
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Affiliation(s)
- Ning-Li Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hui-Kai Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yu Bao
- Department of Gastroenterology and Hepatology, Sichuan Cancer Hospital and Institute, Chengdu 610000, Sichuan Province, China
| | - Wei-Gang Chen
- Department of Gastroenterology, First Affiliated Hospital of School of Medicine, Shihezi University, Shihezi 832002, Xinjiang Uygur Autonomous Region, China
| | - Philip WY Chiu
- Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Tong Dang
- Department of Gastroenterology, the Second Affiliated Hospital of Baotou Medical College, Baotou 014030, Inner Mongolia Autonomous Region, China
| | - Wei Gong
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong Province, China
| | - Shu-Tang Han
- Gastrointestinal Endoscopy Center, Affiliated Hospital of Nanjing Traditional Chinese Medicine University, Nanjing 210029, Jiangsu Province, China
| | - Jian-Yu Hao
- Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Shui-Xiang He
- Department of Gastroenterology, the First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710000, Shaanxi Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Endoscopy, Eastern Hepatobiliary Surgical Hospital Affiliated to Naval Medical University, Shanghai 200438, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Endoscopy, Eastern Hepatobiliary Surgical Hospital Affiliated to Naval Medical University, Shanghai 200438, China
| | - Xiao-Jun Huang
- Department of Gastroenterology, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Yong-Hui Huang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Zhen-Dong Jin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, the Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
| | - James Lau
- Department of Gastrointestinal Endoscopy, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Rui Li
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - De-Liang Liu
- Department of Gastroenterology, Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China
| | - Hai-Feng Liu
- Department of Gastroenterology, General Hospital of Chinese People’s Armed Police Forces, Beijing 100039, China
| | - Jun Liu
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xiao-Gang Liu
- Department of Gastroenterology, Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
| | - Zhi-Guo Liu
- Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
| | - Ying-Cai Ma
- Department of Digestion, Qinghai Provincial People’s Hospital, Xining 810007, Qinghai Province, China
| | - Gui-Yong Peng
- Department of Gastroenterology, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Long Rong
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Wei-Hong Sha
- Department of Gastroenterology and Hepatology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | | | - Jian-Qiu Sheng
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
| | - Shui-Sheng Shi
- Endoscopy Center, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | | | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Gui-Qi Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100020, China
| | - Wen Wang
- Department of General Surgery, Fuzhou General Hospital, Fuzhou 350025, Fujian Province, China
| | - Qi Wu
- Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Hong Xu
- Endoscopy Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Mei-Dong Xu
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ai-Ming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Fang Yao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100020, China
| | - Hong-Gang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, Hubei Province, China
| | - Ping-Hong Zhou
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Bin Zhang
- Endoscopy Center, China-Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Feng Zhang
- Department of Gastroenterology, Hangzhou First People’s Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Ya-Qi Zhai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
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Abstract
PURPOSE OF THE REVIEW The novel concept of third space endoscopy was first applied to humans in 2008 for the management of achalasia through peroral endoscopic myotomy (POEM) procedure. Over the ensuing 10 years, this revolutionary procedure, which started in Japan, has been adopted and mastered by surgeons and gastroenterologists across the globe. In this article, we review the recent innovations and applications of third space endoscopy in the management of esophageal disorders. RECENT FINDINGS With experience and innovation, the application of third-space endoscopy has extended beyond achalasia, and currently, it is used in the management of other esophageal disorders including, spastic esophageal disorders, subepithelial tumors, complete esophageal obstruction, and esophageal diverticula. The recent advances in third space endoscopic procedures have not only permitted endoscopic access to places, previously thought impossible, but also enabled the precision of surgery along with reduced peri-operative morbidity due to its minimally invasive nature. While short- and mid-term outcome studies have shown excellent results, we eagerly await the long-term outcome studies before these procedures could be established as the procedures of choice.
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Affiliation(s)
- Malav P Parikh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Niyati M Gupta
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Du C, Chai NL, Ling-Hu EQ, Li ZJ, Li LS, Zou JL, Jiang L, Lu ZS, Meng JY, Tang P. Submucosal tunneling endoscopic resection: An effective and safe therapy for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. World J Gastroenterol 2019; 25:245-257. [PMID: 30670913 PMCID: PMC6337014 DOI: 10.3748/wjg.v25.i2.245] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/19/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the effectiveness and safety of submucosal tunneling endoscopic resection (STER) and compare its outcomes in esophageal and cardial submucosal tumors (SMTs) of the muscularis propria (MP) layer. METHODS From May 2012 to November 2017, 173 consecutive patients with upper gastrointestinal (GI) SMTs of the MP layer underwent STER. Overall, 165 patients were included, and 8 were excluded. The baseline characteristics of the patients and SMTs were recorded. The en bloc resection rate, complete resection rate, residual rate, and recurrence rate were calculated to evaluate the effectiveness of STER, and the complication rate was recorded to evaluate its safety. Effectiveness and safety outcomes were compared between esophageal and cardial SMTs. RESULTS One hundred and twelve men and 53 women with a mean age of 46.9 ± 10.8 years were included. The mean tumor size was 22.6 ± 13.6 mm. Eleven SMTs were located in the upper esophagus (6.7%), 49 in the middle esophagus (29.7%), 46 in the lower esophagus (27.9%), and 59 in the cardia (35.7%). Irregular lesions accounted for 48.5% of all lesions. STER achieved an en bloc resection rate of 78.7% (128/165) for GI SMTs with an overall complication rate of 21.2% (35/165). All complications resolved without intervention or were treated conservatively without the need for surgery. The en bloc resection rates of esophageal and cardial SMTs were 81.1% (86/106) and 72.1% (42/59), respectively (P = 0.142), and the complication rates were 19.8% (21/106) and 23.7% (14/59), respectively, (P = 0.555). The most common complications for esophageal SMTs were gas-related complications and fever, while mucosal injury was the most common for cardial SMTs. CONCLUSION STER is an effective and safe therapy for GI SMTs of the MP layer. Its effectiveness and safety are comparable between SMTs of the esophagus and cardia.
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Affiliation(s)
- Chen Du
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ning-Li Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Ling-Hu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhen-Juan Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Long-Song Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jia-Le Zou
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Lei Jiang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhong-Sheng Lu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiang-Yun Meng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ping Tang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
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Du C, Chai N, Linghu E, Gao Y, Li Z, Li L, Zhai Y, Lu Z, Meng J, Tang P. Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation. Surg Endosc 2018; 32:4543-4551. [PMID: 29766300 DOI: 10.1007/s00464-018-6206-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Submucosal tunneling endoscopic resection (STER) is increasingly used for the treatment of submucosal tumors (SMTs) originating from the muscularis propria layer; however, endoscopic submucosal excavation (ESE) is still performed in many hospitals for its low-skill and experience requirements. This study aimed to compare STER with ESE for cardial SMTs. METHODS From March 2013 to February 2017, patients with cardial SMTs undergoing STER (n = 47) and ESE (n = 40) were retrospectively assessed. Clinicopathological, endoscopic, and complication data were compared between STER and ESE groups. RESULTS The 87 enrolled patients included 31 females and 56 males, aged 48.2 ± 9.8 years. Mean tumor size was 22.0 mm (range 5.0-80.0 mm) as evaluated by pathology. Demographic and lesion features were similar in both groups. Despite similar hospital stay duration and cost, ESE was superior to STER with reduced operation time (34 vs. 46 min, P = 0.013) and less clips required (3 vs. 5, P = 0.000). En bloc resection rates, complete resection rates, hospital stay duration, cost, complications, and hemoglobin levels were similar in both groups. Irregular-shaped SMTs were more likely to achieve piecemeal resection in both STER and ESE groups (all P < 0.05). Meanwhile, the piecemeal resection rate was significantly higher for larger tumors in the STER group. CONCLUSION Compared with ESE, STER does not show overt advantages for cardial SMTs. However, ESE is superior to STER for reduced operation time. Irregular tumor shape seems to be a risk factor for piecemeal resection in both STER and ESE.
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Affiliation(s)
- Chen Du
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ningli Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Ying Gao
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Zhenjuan Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Longsong Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Yaqi Zhai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Zhongsheng Lu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Jiangyun Meng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ping Tang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
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Huang J, Xian XS, Huang LY, Zhang B, Wu CR, Cui J. Endoscopic full-thickness resection for gastric gastrointestinal stromal tumor originating from the muscularis propria. Rev Assoc Med Bras (1992) 2018; 64:1002-1006. [PMID: 30570051 DOI: 10.1590/1806-9282.64.11.1002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 02/25/2018] [Indexed: 12/28/2022] Open
Abstract
SUMMARY OBJECTIVE: This study retrospectively reviewed 46 cases of gastric gastrointestinal stromal tumors treated by endoluminal endoscopic full-thickness resection (EFR) microsurgery in our gastrointestinal endoscopy center. We aimed to evaluate the EFR for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria. METHODS: A total of 46 patients with gastric gastrointestinal stromal tumors originated from the muscularis propria layer from January 2012 to June 2015 were treated with EFR. The patients were followed up with gastroscope and computed tomography (CT) for evaluation of therapeutic effect and safety. RESULTS: EFR was successfully accomplished to remove all tumors in 46 patients. The mean procedure time was 82.5±39.8min (56-188min). Except in 3 leiomyomas, pathological examination confirmed gastrointestinal stromal tumor (GIST) in 43 cases. None of the patients had occurred bleeding, peritonitis and other complications after EFR. Thereafter, all patients were followed up with gastro-scope after 1, 6,12 months. CONCLUSIONS: EFR is effective and safe for patients with gastric gastrointestinal stromal tumors originated from muscularis propria layer and has the advantage of less invasive treatment and higher tumor resection rate. It should be considered for further application.
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Affiliation(s)
| | - Xiang-Shu Xian
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, China
| | - Liu-Ye Huang
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, China
| | - Bo Zhang
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, China
| | - Cheng-Rong Wu
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, China
| | - Jun Cui
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, China
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Marcella C, Shi RH, Sarwar S. Clinical Overview of GIST and Its Latest Management by Endoscopic Resection in Upper GI: A Literature Review. Gastroenterol Res Pract 2018; 2018:6864256. [PMID: 30515204 PMCID: PMC6234434 DOI: 10.1155/2018/6864256] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/27/2018] [Accepted: 10/14/2018] [Indexed: 02/06/2023] Open
Abstract
AIMS To review the clinical presentation, diagnosis, assessment of risk of malignancy, and recent advances in management (mainly focusing on the role of endoscopic resection) of gastrointestinal stromal tumors (GISTs) in upper GI. METHOD We searched Embase, Web of science, and PubMed databases from 1993 to 2018 by using the following keywords: "gastrointestinal stromal tumors," "GIST," "treatment," and "diagnosis." Additional papers were searched manually from references of the related articles. FINDINGS The improvement of endoscopic techniques in treating upper gastrointestinal subepithelial tumors especially gastrointestinal tumors has reduced the need for invasive surgery in patients unfit for surgery. Many studies have concluded that modified endoscopic treatments are effective and safe. These treatments permit minimal tissue resection, better dissection control, and high rates of en bloc resection with an acceptable rate of complications.
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Affiliation(s)
- Cicilia Marcella
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing 210009, China
| | - Rui Hua Shi
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing 210009, China
| | - Shakeel Sarwar
- Department of Orthopedics, Southeast University Affiliated Zhongda Hospital, Nanjing 210009, China
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