Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2025; 17(3): 95704
Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.95704
Combined application of the preclosure technique and traction approach facilitates endoscopic full-thickness resection of gastric submucosal tumors
Qing-Qing Zu, Yan You, Ai-Zhi Chen, Xiu-Rong Wang, Si-Han Zhang, Feng-Lin Chen, Miao Liu
Qing-Qing Zu, Yan You, Ai-Zhi Chen, Xiu-Rong Wang, Miao Liu, Department of Gastrointestinal Endoscopy Nursing, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Qing-Qing Zu, Feng-Lin Chen, Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou 350001, Fujian Province, China
Si-Han Zhang, Feng-Lin Chen, Department of Gastroenterology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Co-corresponding authors: Feng-Lin Chen and Miao Liu.
Author contributions: Zu QQ, Chen FL study concept and design; You Y, Wang XR, Chen AZ, Zu QQ, Liu M acquisition of data; Zhang SH, You Y, Wang XR, Chen AZ, Zu QQ analysis and interpretation of data; Zu QQ, Chen FL drafting of the manuscript; Zu QQ, You Y, Wang XR, Chen AZ, Liu M, Chen FL critical revision of the manuscript for important intellectual content; Zu QQ, Zhang SH, Chen FL technical material support; Zu QQ, Liu M study supervision. All authors reviewed the results and approved the final version of the manuscript. Chen FL and Liu M played key roles at different stages of the study. One of them put a lot of effort into the experimental design and data collection phase, ensuring the scientific and reliable study. The other has made outstanding contributions to paper writing and theoretical analysis, which has improved the academic depth and readability of the paper. Their joint efforts have refined the results of this research, so co-serving as corresponding authors is a fair recognition of their contributions.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Union Hospital, Fujian Medical University.
Informed consent statement: Given that the study was retrospective in nature and informed consent could not be obtained from patients, an informed consent waiver was requested and approved by the institution.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Miao Liu, MS, Associate Chief Nurse, Department of Gastrointestinal Endoscopy Nursing, Union Hospital, Fujian Medical University, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. 525139924@qq.com
Received: April 16, 2024
Revised: October 4, 2024
Accepted: November 4, 2024
Published online: March 27, 2025
Processing time: 313 Days and 15 Hours
Abstract
BACKGROUND

Gastrointestinal submucosal tumors (SMTs) mostly grew in the lumen, but also some of the lesions were extraluminal, in which the stomach was the most common site. Gastrointestinal stromal tumor account for a large proportion of SMT. Due to the deep lesion location of gastric SMT, endoscopic submucosal dissection related techniques are difficult to operate, while endoscopic full-thickness resection (EFTR) has been widely used in clinical practice because it is less invasive and can preserve the physiological structure and function of the stomach. However, complete closure of the gastrectomy site after EFTR is critical. If the closure is incomplete, it may cause peritonitis, late perforation and other conditions, and even require further surgical intervention. Although there are currently a number of suture devices and techniques that can be used to promote closure, they have the problem of requiring additional equipment or being inconvenient to use. Although metal clips are widely used, their effectiveness depends on the size and tension of the defect. Therefore, an effective and convenient endoscopic closure technique is urgently needed to solve the closure problem of gastric SMTs after treatment.

AIM

To investigate the effect of combined application of the preclosure technique and dental floss traction in gastric wound closure following EFTR.

METHODS

In this study, the data of 94 patients treated for gastric SMTs at the Gastrointestinal Endoscopy Center of the Affiliated Union Hospital of Fujian Medical University from April 2022 to May 2023 were retrospectively analyzed. The patients were divided into a preclosure group (54 patients) and a non-preclosure group (40 patients) on the basis of the timing of wound closure with titanium clips after dental floss traction-assisted EFTR. Each patient in the preclosure group had their wounds preclosed with titanium clips after subtotal lesion resection, whereas each patient in the non-preclosure group had their wounds closed with titanium clips after total lesion resection. The lesion size, wound closure time, number of titanium clips used, incidence of postoperative complications, and postoperative hospitalization time were compared between the two groups.

RESULTS

The wound closure time was significantly shorter in the preclosure group than in the non-preclosure group (6.69 ± 2.109 minutes vs 11.65 ± 3.786 minutes, P < 0.001). The number of titanium clips used was significantly lower in the preclosure group (8.93 ± 2.231) than in the non-preclosure group (12.05 ± 4.495) (P < 0.001). There was no significant difference between the two groups in terms of the need for an indwelling gastric tube or the length of postoperative hospital stay (6.41 ± 1.31 vs 6.13 ± 1.06 days). For all patients in the preclosure group and the non-preclosure group, resection was completed successfully without bleeding, abdominal pain, abdominal distension, or other postoperative complications.

CONCLUSION

Application of the preclosure technique combined with dental floss traction can be used intraoperatively to effectively close the surgical wound in patients undergoing EFTR, reliably preventing the tumor from falling into the peritoneal cavity.

Keywords: Gastric submucosal tumor; Dental floss traction; Endoscopic full-thickness resection; Preclosure technique

Core Tip: Using the endoscopic full-thickness resection (EFTR) technique to treat gastric submucosal tumors, the use of external dental floss traction with endoscopic therapy can provide a clearer surgical field, thereby reducing surgical difficulty and the risk of intraoperative bleeding. In EFTR, the preocclusion technique combined with dental floss traction can effectively close the defect, effectively prevent the tumor from falling into the abdominal cavity. This approach is undoubtedly a reliable defect closure method.