Endoscopic Resection for Gastric Subepithelial Tumor with Backup Laparoscopic Surgery: Description of a Single-Center Experience

Abstract

The aim of this study was to analyze patients who underwent endoscopic resection (ER) for gastric subepithelial tumors (SETs) with a high probability of surgical intervention. Between January 2013 and January 2021, 83 patients underwent ER at the operation theater and 27 patients (32.5%) required backup surgery mainly due to incidental perforation or uncontrolled bleeding despite endoscopic repairing. The tumor was predominantly located in the upper-third stomach (81%) with a size ≤ 2 cm (69.9%) and deep to the muscularis propria (MP) layer (92.8%) but there were no significant differences between two groups except tumor exophytic growth as a risk factor in the surgery group (37% vs. 0%, p < 0.0001). Patients in the ER-only group had shorter durations of procedure times (60 min vs. 185 min, p < 0.0001) and lengths of stay (5 days vs. 7 days, p < 0.0001) but with a higher percentage of overall morbidity graded III (0% vs. 7.1%, p = 0.1571). After ER, five patients (6%) had delayed perforation and two (2.4%) required emergent laparoscopic surgery. Neither recurrence nor gastric stenosis was reported during long-term surveillance. Here, we provide a minimally invasive strategy of endoscopic resection with backup laparoscopic surgery for gastric SETs.

Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors

“…Complete resection of gastric SETs is recommended if the tumor size is > 2 cm, malignant features are present, or if the patient is symptomatic, declined periodical surveillance, and preferred to undergo diagnostic and therapeutic resection. Patients with gastric SETs in the superficial layer underwent ER in the endoscopic room and those with a high probability of surgical intervention were evaluated both by endoscopists and general surgeons preoperatively[ 16 , 18 ]. ER with backup surgery was indicated for patients with endoscopic intent, and a small tumor size tolerated the endoscopic retrieval.…”

“…The ER of small gastric SETs (< 5 cm) involves a shorter surgery and less intraoperative blood loss in selected cases of intraluminal tumors[ 14 , 15 ]. By considering complications, such as perforation or bleeding, we modified the LECS procedure as a backup laparoscopic surgery to provide timely management, which required more operative time but reduced postoperative morbidity[ 16 ].…”

Retraction: Comparing the controlled attenuation parameter using FibroScan and attenuation imaging with ultrasound as a novel measurement for liver steatosis

“…The ethics approval number (210202) in [ 1 ] is also reported in several articles by some of the same authors, including [ 3 – 7 ], which describe studies and patient cohorts different to those reported in [ 1 ]. Additionally, discrepancies were identified between the description of the study design in [ 1 ] and the ethics approval documentation provided during discussions.…”

“…Hence, the article does not adhere to the journal's second publication criterion or PLOS' Editorial policies pertaining to text reuse and publication of related studies, and concerns remain regarding partial redundancy of the two articles [1,2].The ethics approval number (210202) in [1] is also reported in several articles by some of the same authors, including [3-7], which describe studies and patient cohorts different to those reported in [1]. Additionally, discrepancies were identified between the description of the study design in [1] and the ethics approval documentation provided during discussions.The first author stated that the same approval number (210202) was obtained for multiple different studies [1,[3][4][5][6][7] as the applications for approval for all the studies were made to the IRB together. They also acknowledged that the study described in [1] was retrospective, which conflicts with the description of the study design in [1].…”

“…The first author stated that the same approval number (210202) was obtained for multiple different studies [1,[3][4][5][6][7] as the applications for approval for all the studies were made to the IRB together. They also acknowledged that the study described in [1] was retrospective, which conflicts with the description of the study design in [1].…”