Retrospective Comparison of Endoscopic Full-Thickness Versus Laparoscopic or Surgical Resection of Small (≤ 5 cm) Gastric Gastrointestinal Stromal Tumors

Zhao, Yan; Pang, Taohong; Zhang, Bin; Wang, Lei; Lv, Ying; Ling, Tao; Zhang, Xiaoqi; Huang, Qin; Xu, Guifang; Zou, Xiaoping

doi:10.1007/s11605-019-04493-6

Cited by 27 publications

(32 citation statements)

References 30 publications

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“…2 , 6 Endoscopic resection has several advantages over surgical methods, such as it is minimally invasive, associated with a shorter hospital stay, and has a lower cost. 6 – 9 Available endoscopic methods include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), endoscopic full-thickness resection (EFTR), and submucosal tunneling endoscopic resection (STER). 10 , 11 ESD is only recommended for SMTs that originate from the superficial muscularis propria (MP) layer.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

et al. 2021

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Objective Endoscopic submucosal excavation (ESE) has been established as an effective method for removal of gastric submucosal tumors (SMTs). The aim of the present study was to explore risk factors for technical difficulties in ESE. Methods In this retrospective study, we collected clinical data from patients who underwent ESE for gastric SMTs. Difficult ESE was defined as a procedure time ≥90 minutes, piecemeal resection, and/or occurrence of major adverse events. Univariate and multivariate analyses were performed to explore the risk factors for a difficult ESE. Results ESE was successfully performed in 96.5% (195/202) of patients from April 2011 to December 2019. The average tumor size was 17.41 mm, and en bloc resection was achieved in 97.4% of patients (190/195). Five patients (2.56%, 5/195) had complications, including two with delayed bleeding, two with fever, and one with chest pain accompanying ST-T changes in an electrocardiogram. Twenty-four patients (11.88%, 24/202) had a difficult ESE. Logistic analysis showed that outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE. Conclusion ESE may be safe and effective to treat patients with gastric SMTs. Outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE.

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Section: Introductionmentioning

confidence: 99%

Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

et al. 2021

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“…For GISTs less than 5 cm, laparoscopic surgery was considered to be a suitable choice. [ 10 ] In recent years, with the further maturity of endoscopic technology, endoscopists have tried to expand the indications of endoscopic resection for GISTs; [ 34 , 35 ] for these reasons, we identified many relevant studies. Our meta-analysis also found that there was no significant difference between ER and LAP in terms of blood loss, hospitalization costs, complications, recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

“…With the rapid development of minimally invasive methods, laparoscopic resection (LAP) is believed to have similar long-term effects to those of open surgery for GISTs and to have advantages in terms of blood loss and length of hospital stay. [ 8 , 9 ] Because small GISTs show indolent growth behavior and rarely metastasize to lymph nodes, [ 10 ] endoscopic resection (ER), including endoscopic full-thickness resection (EFR), endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER), has also become a viable option for small GISTs. [ 11 , 12 ]…”

Section: Introductionmentioning

confidence: 99%

“…A large number of studies have demonstrated advantages and disadvantages of endoscopic resection over those of laparoscopic resection for small GISTs (≤5 cm). [ 10 , 13 – 22 ] Nevertheless, the results of head-to-head comparison are conflicting, especially with respect to long-term outcomes. Although laparoscopic and endoscopic cooperative surgery (LECS) that combines laparoscopic and endoscopic methods has become popular in recent years, it remains debatable as to whether it has an advantage over the two original methods.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic or laparoscopic resection for small gastrointestinal stromal tumors: a cumulative meta-analysis

Cai

Liang

et al. 2020

Chinese Medical Journal

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Background Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors (GISTs) (diameter ≤ 5 cm), the results remain conflicting. The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs. laparoscopic resection. Methods The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched medical databases up to January 2020. Meta-analytical random or fixed effects models were used in pooled analyses. Meta-regression, cumulative meta-analyses, and subgroup analyses were performed to improve the accuracy of the conclusion. Sensitivity analyses were applied to assess the robustness of the results. Results A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified, while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found. We found that endoscopic resection had shorter operation times (weighted mean difference [WMD] = –27.1 min, 95% confidence interval [CI]: –40.8 min to –13.4 min) and lengths of hospital stay (WMD = –1.43 d, 95% CI: –2.31 d to –0.56 d) than did laparoscopic resection. The results were stable and reliable. There were no significant differences in terms of blood loss, hospitalization costs, incidence of complications or recurrence rates. For tumor sizes 2 – 5 cm, endoscopic resection increased the risk of positive margins (relative risk [RR] = 5.78, 95% CI: 1.31 – 25.46). Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery (WMD = –41.03 min, 95% CI: –59.53 min to –22.54 min), there was a higher incidence of complications (RR = 4.03, 95% CI: 1.57 – 10.34). Conclusions In general, endoscopic resection is an alternative method for gastric GISTs ≤ 5 cm. Laparoscopic and endoscopic cooperative surgery may work well in combination. Further randomized controlled trials are recommended to validate or update these results.

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“…Furthermore, with regard to major adverse events, one case of delayed bleeding and one case of abdominal infection were reported across the included study. The first required laparoscopic suturing due to evidence of hemorrhage on the serosal surface of the surgical site[ 13 ], while the latter resolved after antibiotic treatment[ 14 ].…”

Section: Closure Techniques For Gastric Post-eftr Defectmentioning

confidence: 99%

Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era

Granata¹,

Martino²,

Ligresti³

et al. 2021

WJGS

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Exposed endoscopic full-thickness resection (EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors. To date, various techniques have been used for the closure of the transmural post-EFTR defect, mainly consisting in clip- and endoloop-assisted closure methods. However, the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure. The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance, also considering the recent advent of flexible endoscopic suturing.

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Retrospective Comparison of Endoscopic Full-Thickness Versus Laparoscopic or Surgical Resection of Small (≤ 5 cm) Gastric Gastrointestinal Stromal Tumors

Cited by 27 publications

References 30 publications

Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

Endoscopic or laparoscopic resection for small gastrointestinal stromal tumors: a cumulative meta-analysis

Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era

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