Mucosectomy device‐assisted endoscopic resection of gastric subepithelial lesions

Abstract

Objective: Some gastrointestinal subepithelial tumors (SETs) have malignant potential and complete resection may be required. However, endoscopic submucosal dissection (ESD) can be a tedious procedure and requires a long and extensive training to master. Devices for endoscopic full-thickness resection (EFTR) are limited and are not widely available. We report here a simpler endoscopic method to resect small SETs using a commercially available endoscopic mucosal resection (EMR) kit and enucleation technique.Methods: All patients with SET who underwent device-assisted resection at our tertiary care hospital from April 2015 to November 2016 were enrolled in this retrospective study. All procedures were performed by a single expert endoscopist with an advanced endoscopy trainee. A mucosectomy and a limited dissection under mucosa were performed to preserve the mucosa before a deviceassisted enucleation of the tumor to facilitate endoscopic closure of the defect closure in all cases.Results: A total of 12 patients aged 38-70 y, of whom six were males, were included.Most of the tumors originated from the muscularis propria and were located at the proximal gastric body. The mean procedural duration was 53 minutes (range 23-91 min). The average size of the lesions was 13 mm (range 9-21 mm). The mean duration of hospitalization was 1.3 days. Bleeding and intentional perforation were all successfully managed during the procedure and did not result in any clinically significant adverse event.Conclusion: A device-assisted EFTR using a commercially available EMR kit is a safe and feasible method for the endoscopic resection of small gastric extrovert SETs. K E Y W O R D S endoscopic resection, gastrointestinal stromal tumors, ligation, subepithelial tumor † These two authors contributed equally to this study. Eight of these cases have been described at the 2017 Digestive Disease Week in Chicago, USA and has been published on the Gastroenterol Endosc. 2017;85(Suppl):AB517.

Present situation of minimally invasive surgical treatment for early gastric cancer

“…The EFTR technique was first introduced in Japan in 1998[ 25 ], and subsequently the same team reported that it is safe and reliable for completely closed early gastrointestinal malignancies tumors[ 26 ]. The use of commercially available EMR kit devices to assist EFTR has been shown to be a safe and feasible approach for endoscopic resection of gastrointestinal SETs with malignant potential SET[ 27 ]. Mucosal resection and limited submucosal dissection to preserve the mucosa prior to tumor resection in SET patients may facilitate postoperative recovery.…”