Long-term outcomes of combined endoscopic/laparoscopic intragastric enucleation of presumed gastric stromal tumors

Mino, Jeffrey; Guerron, Alfredo D.; Monteiro, Rosebel; El‐Hayek, Kevin; Ponsky, Jeffrey L.; Patil, Deepa T.; Walsh, R. Matthew

doi:10.1007/s00464-015-4416-2

Cited by 21 publications

(7 citation statements)

References 28 publications

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“…[ 2 ] However, smaller tumors (<20–30 mm) can be safely considered for endoscopic resection, with or without laparoscopic control. [ 20 21 ] Consequently, NCCN guidelines recommend follow-up only in tumors <20 mm without high-risk EUS features while the rest should be resected. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors

et al. 2017

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Background and Objectives:Gastrointestinal stromal tumors (GISTs) represent the largest group of subepithelial tumors (SET) of the upper gastrointestinal (GI) tract. They may show malignant behavior, in contrast to other SET. Endoscopic ultrasound (EUS) is frequently used to characterize SET. With the introduction of contrast-enhanced ultrasound (CEUS) into EUS (CE-EUS), distinct enhancement patterns can be detected. In the presented study, the characteristic features of CE-EUS in GIST are analyzed and compared with those of other SET.Materials and Methods:Consecutive patients from four centers with SET of the upper and middle GI tract were included and received endoscopic or transcutaneous CEUS. The results were compared with EUS-guided tissue acquisition, forceps biopsy, or surgical resection.Results:Forty-two out of 62 (68%) patients had SET of the stomach, 17/62 (27%) of the small intestine, 2/62 (3%) of the esophagus, and 1/62 (2%) extraintestinal. Eighty-one percent underwent surgery. Leiomyoma was found in 5/62 (8%) and GIST in 57/62 patients (92%). Thirty-nine out of 57 (68%) patients had GIST lesions in the stomach, 17/57 (30%) had GIST of the small intestine, and 1/57 (2%) patients had extraintestinal GISTs. GIST size was 62.6 ± 42.1 (16–200) mm. Hyperenhancement had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 98%, 100%, 100%, 93%, and 98% for the diagnosis of GIST. Fifty out of 57 patients with GIST (88%) showed avascular areas in the center of the lesions.Conclusion:CE-EUS and CEUS show hyperenhancement and avascular areas in a high percentage of GIST but not in leiomyoma. Thus, GIST and leiomyoma can be discriminated accurately.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors

et al. 2017

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“…The resected specimen is placed in a plastic bag (Rusch MemoBag; Teleflex, Tokyo, Japan) and removed intraluminally using endoscopy if the size of the tumor is ≤ 5 cm[ 20 , 80 ]. Larger tumors of > 5 cm are removed trough the umbilicus with a plastic bag.…”

Section: Oral Approach By Endoscopic Visualizationmentioning

confidence: 99%

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Aisu¹,

Yasukawa²,

Kimura³

et al. 2018

WJGO

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Laparoscopic and endoscopic cooperative surgery (LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors (GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to avoid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according to the concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.

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“…Moreover, it is often difficult to extract the purified data of only PEIGS cases, while they contain mixed operative methods and results of unclassified groups. Mino et al (29) reported the long-term outcomes of 15 cases, who were followed up for max. 61 months and presented no recurrence.…”

Section: Oncological Outcomesmentioning

confidence: 99%

Percutaneous endoscopic intragastric surgery: an organ preserving approach to submucosal tumors at esophagogastric junction

Kanehira

Tanida

et al. 2017

Transl. Gastroenterol. Hepatol.

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As an organ preserving option in the treatment of submucosal tumor found at the esophagogastric junction (EGJ), percutaneous endoscopic intragastric surgery (PEIGS) plays an important role, while it is not commonly performed and there have been very few reports on this unique operation. The current authors have been performing PEIGS since 1993 and have reported on its short- and long-term outcomes from one of the world largest series. Herein its confusing terminology is discussed and techniques of three different types of PEIGS (original PEIGS, single incision PEIGS, and needlescopic PEIGS) are precisely described. Although reports on clinical outcomes of PEIGS have been rarely published, both short-term and long-term outcomes seem acceptable, as far as we review our own experiences and the past literatures. PEIGS needs to be accessed by the data from larger series or RCT to be further justified and spread for the patients with submucosal tumors at EGJ to salvage their stomach.

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Long-term outcomes of combined endoscopic/laparoscopic intragastric enucleation of presumed gastric stromal tumors

Abstract: Enucleation of intact gastrointestinal stromal tumors can be accomplished with low risk of recurrence when done with a combined endoscopic/laparoscopic intraluminal technique. It should be the preferred approach considered for small, proximal, intraluminal tumors.

Cited by 21 publications

References 28 publications

Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors

Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Percutaneous endoscopic intragastric surgery: an organ preserving approach to submucosal tumors at esophagogastric junction

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