Gastric defect closure after endoscopic full-thickness resection: the closing while dissecting technique

Sun, Haibo; Cao, Tingting; Zhang, Fan; Tao, Ke; Xu, Hong

doi:10.1007/s00464-022-09457-7

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…Fourth, the closure procedure is performed before the tumor is totally resected as described. This method involves making relatively small perforations that can be closed by clips and minimizing intraperitoneal contact with gastric contents and air as much as possible 10 . Early defect closure also helps avoid edema and ectropion of the resect margins after a long resection time, which helps with the complete clipping of the defect.…”

Section: Discussionmentioning

confidence: 99%

“…This method involves making relatively small perforations that can be closed by clips and minimizing intraperitoneal contact with gastric contents and air as much as possible. 10 Early defect closure also helps avoid edema and ectropion of the resect margins after a long resection time, which helps with the complete clipping of the defect. Fifth, the novel method is easy to perform, economical, and convenient, requiring no special auxiliary equipment.…”

Section: Discussionmentioning

confidence: 99%

“…With advances in endoscopic techniques, exposed endoscopic full‐thickness resection (Eo‐EFTR), which creates an intentional perforation and resects the tumor with the full thickness of the stomach wall, has proven to be an effective and minimally invasive treatment for gastric SMTs originating from the deep muscularis propria layer or with extraluminal growth 6–9 . The resection procedure is challenging, with a need to create adequate exposure of the operative field of vision, a risk of tumor falling into the peritoneal cavity, and in particular, subsequent defect closure to avoid peritonitis, pneumoperitoneum, and late perforation 10 . In recent years, some suture devices and modalities have been developed to simplify the closure, such as endoloop and clips that are used for purse‐string suture, 11,12 the OverStitch system, 13 and the over‐the‐scope clip (OTSC) 14 .…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] The resection procedure is challenging, with a need to create adequate exposure of the operative field of vision, a risk of tumor falling into the peritoneal cavity, and in particular, subsequent defect closure to avoid peritonitis, pneumoperitoneum, and late perforation. 10 In recent years, some suture devices and modalities have been developed to simplify the closure, such as endoloop and clips that are used for purse-string suture, 11,12 the OverStitch system, 13 and the over-the-scope clip (OTSC). 14 However, their extensive use has been limited by the need for extra equipments and the difficult operation.…”

Section: Introductionmentioning

confidence: 99%

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A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

Nan

et al. 2023

J of Digest Diseases

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Objectives: Exposed endoscopic full-thickness resection (Eo-EFTR) has proven effective and economical for patients with gastric submucosal tumors (SMTs), showing great prospects. However, the poor operative field of view, the risk of tumors falling into the peritoneal cavity, especially the difficulties in defect closure, have limited its widespread application. Herein, we described a modified traction-assisted Eo-EFTR technique aimed at simplifying both the dissection and defect closure procedures.Methods: Nineteen patients who underwent the modified Eo-EFTR for gastric SMTs in the Chinese People's Liberation Army General Hospital were enrolled in the study. Following a 2/3 circumferential full-thickness incision, a clip with dental floss was anchored to the resected part of the tumor surface. With the dental floss traction, the gastric defect was reshaped into a V shape, which facilitated the deployment of clips to close the defect. The defect closure and tumor dissection procedures were then performed alternately. Patients' demographics, tumor characteristics, and therapeutic outcomes were evaluated retrospectively. Results: All tumors had an R0 resection. The median procedure time was 43 min (range 28-89 min). No severe perioperative adverse events occurred. Two patients experienced transient fever, and three patients complained of mild abdominal pain on the first day after the operation. All patients recovered on the next day with conservative management. No residual lesion or recurrence was reported during the follow-up period of 30.1 months. Conclusion:The safety and practicability of the modified technique might allow for wide clinical applications of Eo-EFTR in gastric SMTs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

Nan

et al. 2023

J of Digest Diseases

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“…Endoscopic hand suturing with clips for a large defect after endoscopic full-thickness resection of gastric gastrointestinal stromal tumor Few studies have focused on endoscopic full-thickness resection (EFTR) for gastric gastrointestinal stromal tumors (g-GISTs) ≥35 mm [1], which could be attributed to the difficulty of endoscopic resection and closure of the defect, although multiple closure techniques have been developed for post-EFTR defects [2][3][4]. Recently, endoscopic hand-suturing (EHS) has been proved safe and effective for gastrointestinal superficial defects [5], and can be expected to be similarly efficacious for closing large defects after EFTR.…”

mentioning

confidence: 99%

Endoscopic hand suturing with clips for a large defect after endoscopic full-thickness resection of gastric gastrointestinal stromal tumor

Wu,

Liu,

Song

et al. 2024

Endoscopy

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Safety and efficacy of a modified endoscopic full-thickness resection technique for gastric submucosal tumors: a case series

Zhou,

Huang,

Cheng

et al. 2024

Front. Oncol.

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ObjectivesEndoscopic full-thickness resection (EFTR) has proven effective and economical for patients with gastric submucosal tumors (SMTs). However, the poor operative field of view, the risk of massive hemorrhage, and the difficulties in defect closure have limited its widespread application. Herein, we described a modified EFTR technique developed to simplify the dissection and defect closure procedures using common and economical endoscopic accessories.MethodsForty-two patients who underwent the modified EFTR for gastric SMTs in the Shenzhen Guangming District People’s Hospital were enrolled in the case series. Following a cross incision to expose the intraluminal surface the tumors were captured by suction through a transparent cap and the roots were ligated using a loop. The tumors and part of the suction tissue were removed along the ligated root. A tension-relieving closure was performed by clipping the raised plica in four quadrants outside the ligated root. Patient demographics, tumor characteristics, and therapeutic outcomes were evaluated retrospectively.ResultsAll tumors had an R0 resection. The median procedure time was 51.8 min (IQR 34.25 min). No severe perioperative adverse events occurred. No residual lesion or recurrence was reported during the follow-up period of 9.84 months (IQR 5.0 months).ConclusionThe safety and practicability of Modified-EFTR could allow for wide clinical application in patients with micro-gastric SMTs.

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Gastric defect closure after endoscopic full-thickness resection: the closing while dissecting technique

Cited by 4 publications

References 24 publications

A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

Endoscopic hand suturing with clips for a large defect after endoscopic full-thickness resection of gastric gastrointestinal stromal tumor

Safety and efficacy of a modified endoscopic full-thickness resection technique for gastric submucosal tumors: a case series

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