Current Status of Exposed Endoscopic Full-Thickness Resection and Further Development of Non-Exposed Endoscopic Full-Thickness Resection

Mori, Hideki; Rahman, Asadur; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Ayaki, Maki; Matsunaga, Tae; Murakami, Masanori; Masaki, Tsumomu

doi:10.1159/000452352

Cited by 18 publications

(14 citation statements)

References 44 publications

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“…Non-exposed EFTR has a good chance of becoming a method of choice in selected cases of gastrointestinal tumor man-agement. In this procedure, the lesion is secured with a fullthickness device before cutting [2]. The technique requires serosa-to-serosa apposition.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2019

Endosc Int Open

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Endoscopic full-thickness resection (EFTR) is used to achieve RO resection and as a way to overcome the limitations of endoscopic submucosal dissection (ESD) in management of lesions arising or infiltrating the muscularis propria (subepithelial tumor [SET]) as well as non-lifting or partially-treated adherent lesions[1]. Multiple techniques have been described over time [2]. Exposed techniques, consisting of creating an open wound followed by secured closure, are already used in selected cases. These techniques include submucosal tunneling with endoscopic resection (STER) [3, 4], endoscopic submucosal excavation (ESE) [5], and endoscopic full-thickness resection with secondary closure (exposed EFTR) [6, 7]. Exposed EFTR was initially associated with safety problems, infection, and dissemination [8], leading to emergence of nonexposed techniques. Non-exposed techniques involve placing clips or sutures around the lesion before resection. For that purpose, dedicated clipping/snaring devices have been developed. These allow EFTR for small lesions but limitations still exist for targeting larger areas [9]. Therefore, although it has been proven over the last decade that endoscopic exposed techniques are now safe and feasible with limited risk of dissemination when performed by a skilled

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Section: Discussionmentioning

confidence: 99%

Untitled

2019

Endosc Int Open

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“…intraperitoneal contamination by the gastric contents, and dissemination of tumor cells within the peritoneal cavity. 11 Moreover, if the size of the tumor is large, closure of the defect is technically challenging. Current endoscopic instruments are not ideally suitable for performing full-thickness suturing while maintaining insufflation of the gastrointestinal tract.…”

Section: Disadvantagesmentioning

confidence: 99%

Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions

Kaan

2020

Clin Endosc

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Standard polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are established techniques for the treatment of gastrointestinal tumors. However, resection of submucosal tumors via ESD often results in low rates of microscopically margin-negative (R0) resection and high rates of perforation. Endoscopic full thickness resection (EFTR) overcomes this adverse event and aids in the therapeutic management of complex tumors. Multiple techniques for EFTR have been developed, each with its own advantages and disadvantages. Submucosal tunneling and nonexposed techniques are generally preferable, because the layer of overlying intact mucosa reduces the incidence of intraperitoneal contamination by the gastric fluid and dissemination of the tumor cells. However, adoption of EFTR by endoscopists in clinical practice remains low. The major challenge seems to be the technical difficulty in performing laparoscopic and/or endoscopic suturing using the currently available instruments. We developed a novel robotic endoscopic platform with suturing capabilities to overcome the technical challenges of suturing. This platform allows easy maneuvering and triangulation of the instruments, thus facilitating endoscopic suturing using robotic arms. Our studies have demonstrated that this robotic endoscopic platform with suturing capabilities is an effective and safe method for performing EFTR with endoscopic suturing.

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“…However, in cancer cases, the full-thickness resection techniques without transluminal access seem to be important to avoid the risk of tumor seeding [23]. Non-exposed endoscopic wall-inversion surgery (NEWS) was developed as a new useful technique of endoscopic fullthickness resection of the stomach without intentional perforation for early gastric cancer (Fig.…”

Section: Laparoscopic Sn Basin Dissection and Precision Medicinementioning

confidence: 99%

Minimally Invasive Function-Preserving Gastrectomy with Sentinel Node Biopsy for Early Gastric Cancer

et al. 2018

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Background: Recently, minimally invasive approaches such as endoscopic treatment or laparoscopic gastrectomy for early gastric cancer have made rapid progress. However, the extent of gastrectomy and lymphadenectomy in laparoscopic surgery is radical, similar to that of open gastrectomy for patients with early gastric cancer diagnosed as not indicated for endoscopic treatment. Since it is well known that lymph node metastasis is an important prognostic factor, the standard procedure of gastrectomy with radical lymph node dissection has been performed for the purpose of curative resection. The frequency of lymph node metastases is relatively low in patients with early gastric cancer; therefore, function-preserving gastrectomy, a solution between endoscopic treatment and standard gastrectomy in terms of invasiveness, could be considered to avoid excessive invasive surgery. Summary: A prospective multicenter trial and meta-analyses of sentinel node (SN) mapping and biopsy for early gastric cancer demonstrated favorable SN detection rates and accuracy of nodal metastatic status. Personalized function-preserving gastrectomy with limited lymphadenectomy using SN theory will positively impact patients’ quality of life (QOL). Specifically, a full-thickness partial gastrectomy by laparoscopic endoscopic cooperative surgery with SN basin dissection could become a reliable technique of minimally invasive gastrectomy for treating patients with clinically node-negative (cN0) early gastric cancer. Key Messages: For early gastric cancer, the development of laparoscopic personalized minimized gastrectomy with SN navigation may improve patients’ postoperative QOL.

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Current Status of Exposed Endoscopic Full-Thickness Resection and Further Development of Non-Exposed Endoscopic Full-Thickness Resection

Cited by 18 publications

References 44 publications

Untitled

Untitled

Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions

Minimally Invasive Function-Preserving Gastrectomy with Sentinel Node Biopsy for Early Gastric Cancer

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