Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus

Abstract

Background and aims: Endoscopic full-thickness resection (EFTR) is difficult to perform in a retroflexed fashion in the gastric fundus. The present study aims at exploring whether direct EFTR can be a simple, effective and safe procedure to treat intraluminal-growth submucosal tumors originating from the muscularis propria. Methods: The patients with intraluminal-growth submucosal tumors originating from the muscularis propria in gastric fundus treated by direct EFTR between 01 January 2017 and 01 September 2018 were retrospectively reviewed. In addition, we analyzed the patients with intraluminal-growth submucosal tumors originating from the muscularis propria in gastric fundus treated by traditional EFTR. The differences in tumor resection time, costeffectiveness, and complication rate were evaluated. Results: Forty patients were enrolled in the present study, 20 patients of which were in the direct EFTR group and 20 patients of which were in the traditional EFTR group. En-bloc resections of gastric tumors were successfully performed in all 40 cases. There was no significant difference in the average tumor size of the two groups (24.3 ± 2.9 mm in direct EFTR group verus 24.0 ± 2.6 mm in the traditional group, p = 0.731), but significant difference existed in the operative time between two groups (35.0 ± 8.2 min in direct EFTR group verus 130.6 ± 51.9 min in the traditional group, p<0.05). No complications, such as postoperative bleeding and perforation, occurred in any groups. Conclusions: Direct EFTR is a safe, simple and cost-effective procedure for SMTs with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus.

Endoscopic full‐thickness resection, indication, methods and perspectives

“…T O PROVIDE ROBUST data on EFTR safety and outcomes, we conducted a brief meta-analysis, including published randomized controlled trials, nonrandomized concurrent controlled trials, case-control studies, cohort studies and serial case reports (>10 cases), [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] for GI SMTs, during which the number of publications witnessed booming.…”

Endoscopic full‑thickness resection with clip‑ and snare‑assisted traction for gastric submucosal tumours in the fundus: A single‑centre case series

“…Therefore, 20 cases of gastric SMTs in the fundus originating from the MP were treated with Eo-EFTR. Due to the need for retroflexion of the endoscope when tumours are located in the gastric fundus, the gastroscope has difficulty getting close to the deep part of lesions, which increases the difficulty of complete resection (36,60,61). Given this, plenty of auxiliary traction options have been developed for use during endoscopic treatment, including the clip-with-line method, snare traction, clip-snare traction, grasping forceps traction, transparent cap traction, the suture loop needle-T tag tissue anchors method, the robot-assisted method, and magnetic anchor technology (62).…”

“…Data from 20 patients who underwent EUS and abdominal computed tomography (CT) before undergoing Eo-EFTR for SMTs in the gastric fundus at the First Affiliated Hospital of Soochow University from April 2018 to December 2021 were retrospectively enrolled. The median age of the patients was 58 (50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68) years.…”

Endoscopic Full Thickness Resection: A Systematic Review

“…81 Clip in line traction method, cap-assisted technique (in small GIST < 1.5 cm) and direct EFTR (for gastric fundal SELs with intraluminal growth pattern) can reduce the operating time. 82 83 84 85 Snare-assisted EFTR was shown to be cost effective compared with band ligation-assisted or ESD-assisted EFTR with similar efficacy and complication rates. 86 Omental patch, suturing device, or endoscopic loop ligation can be used for defect closure.…”