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01-08-2017 | Dynamic Manuscript

Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer

Authors: Yuyong Tan, Xiaoyu Tang, Ting Guo, Dongzi Peng, Yao Tang, Tianying Duan, Xuehong Wang, Liang Lv, Jirong Huo, Deliang Liu

Published in: Surgical Endoscopy | Issue 8/2017

Abstract

Background

Both submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR) are effective method for treating gastric gastrointestinal stromal tumors (GISTs); however, little is known about the comparison between STER and EFTR. The aim of the study was to compare the safety and efficacy of STER and EFTR for treating gastric GIST.

Methods

We retrospectively collected the clinical data about patients with gastric GISTs who received STER or EFTR at our hospital from April 2011 to June 2016. Epidemiological data (gender, age), tumor size, procedure-related parameters, complications, length of stay, cost and follow-up data were compared between STER and EFTR.

Results

A total of 52 patients were enrolled, and 20 of them received STER, while the other 32 cases received EFTR. There was no significant difference between the two groups in terms of gender, age, concomitant diseases, tumor size, en bloc resection rate, operation time, complications, pathohistological grade of GIST, hospital stay and cost (P > 0.05). However, patients who received EFTR had a longer suture time and needed more clips to close the gastric-wall defect (STER vs EFTR, 291.5 ± 68.7 vs 380.6 ± 96.9s and 6.0 ± 1.2 vs 7.6 ± 1.6, P < 0.05). No recurrence was noted in the STER and EFTR groups during a mean follow-up of 10.9 and 23.8 months, respectively.

Conclusions

The treatment efficacy between STER and EFTR for treating gastric GISTs was comparable, and a large-scale, randomized study is necessary for a more confirmed conclusion.

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Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 8(Suppl 2):S1–41 (quiz S42–44) CrossRefPubMedPubMedCentral

Koga T, Hirayama Y, Yoshiya S, Taketani K, Nakanoko T, Yoshida R, Minagawa R, Kai M, Kajiyama K, Akahoshi K, Maehara Y (2015) Necessity for resection of gastric gastrointestinal stromal tumors ≤20 mm. Anticancer Res 35(4):2341–2344PubMed

Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY (2009) Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):64–67PubMed

Yang J, Feng F, Li M, Sun L, Hong L, Cai L, Wang W, Xu G, Zhang H (2013) Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors. World J Surg Oncol 11:273CrossRefPubMedPubMedCentral

Fang YJ, Cheng TY, Sun MS, Yang CS, Chen JH, Liao WC, Wang HP (2012) Suggested cutoff tumor size for management of small EUS-suspected gastric gastrointestinal stromal tumors. J Formos Med Assoc 111(2):88–93CrossRefPubMed

Meng Y, Cao C, Song S, Li Y, Liu S (2016) Endoscopic band ligation versus endoscopic submucosal dissection and laparoscopic resection for small gastric stromal tumors. Surg Endosc 30(7):2873–2878CrossRefPubMed

Feng F, Liu Z, Zhang X, Guo M, Xu G, Ren G, Hong L, Sun L, Yang J, Zhang H (2015) Comparison of endoscopic and open resection for small gastric gastrointestinal stromal tumor. Transl Oncol 8(6):504–508CrossRefPubMedPubMedCentral

Kim HH (2015) Endoscopic treatment for gastrointestinal stromal tumor: Advantages and hurdles. World J Gastrointest Endosc 7(3):192–205CrossRefPubMedPubMedCentral

Joo MK, Park JJ, Kim H, Koh JS, Lee BJ, Chun HJ, Lee SW, Jang YJ, Mok YJ, Bak YT (2016) Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract. Gastrointest Endosc 83(2):318–326CrossRefPubMed

10.

Park JJ (2016) Long-term outcomes after endoscopic treatment of gastric gastrointestinal stromal tumor. Clin Endosc 49(3):232–234CrossRefPubMedPubMedCentral

11.

Zhou PH, Yao LQ, Qin XY, Cai MY, Xu MD, Zhong YS, Chen WF, Zhang YQ, Qin WZ, Hu JW, Liu JZ (2016) Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25(9):2926–2931CrossRef

12.

Guo J, Liu Z, Sun S, Liu X, Wang S, Ge N, Wang G, Qi Y (2015) Endoscopic full-thickness resection with defect closure using an over-the-scope clip for gastric subepithelial tumors originating from the muscularis propria. Surg Endosc 29(11):3356–3362CrossRefPubMedPubMedCentral

13.

Chiu PW, Phee SJ, Wang Z, Sun Z, Poon CC, Yamamoto T, Penny I, Wong JY, Lau JY, Ho KY (2014) Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by Overstitch: a preclinical study. Surg Endosc 28(1):319–324CrossRefPubMed

14.

Schlag C, Wilhelm D, von Delius S, Feussner H, Meining A (2013) EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy 45(1):4–11PubMed

15.

Lu J, Zheng M, Jiao T, Wang Y, Lu X (2014) Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy 46(10):888–892CrossRefPubMed

16.

Li QL, Chen WF, Zhang C, Hu JW, Zhou PH, Zhang YQ, Zhong YS, Yao LQ, Xu MD (2015) Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc 29(12):3640–3646CrossRefPubMed

17.

Lu J, Jiao T, Li Y, Liu Y, Wang Y, Wang Y, Zheng M, Lu X (2015) Heading toward the right direction–solution package for endoscopic submucosal tunneling resection in the stomach. PLoS ONE 10(3):e0119870CrossRefPubMedPubMedCentral

18.

Wang H, Tan Y, Zhou Y, Wang Y, Li C, Zhou J, Duan T, Zhang J, Liu D (2015) Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol 27(7):776–780CrossRefPubMed

19.

Honda M, Hiki N, Nunobe S, Ohashi M, Kiyokawa T, Sano T, Yamaguchi T (2014) Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors. Surg Endosc 28(8):2317–2322CrossRefPubMed

20.

Chen QL, Pan Y, Cai JQ, Wu D, Chen K, Mou YP (2014) Laparoscopic versus open resection for gastric gastrointestinal stromal tumors: an updated systematic review and meta-analysis. World J Surg Oncol 12:206CrossRefPubMedPubMedCentral

21.

Maple JT, Abu DBK, Chauhan SS, Hwang JH, Komanduri S, Manfredi M, Konda V, Murad FM, Siddiqui UD, Banerjee S (2015) Endoscopic submucosal dissection. Gastrointest Endosc 81(6):1311–1325CrossRefPubMed

22.

Zhang Y, Ye LP, Mao XL (2015) Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer. World J Gastroenterol 21(32):9503–9511CrossRefPubMedPubMedCentral

23.

Zhang Y, Ye LP, Zhou XB, Mao XL, Zhu LH, He BL, Huang Q (2013) Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer: results from a large study in China. J Clin Gastroenterol 47(8):689–694CrossRefPubMed

24.

Suzuki H, Ikeda K (2001) Endoscopic mucosal resection and full thickness resection with complete defect closure for early gastrointestinal malignancies. Endoscopy 33(5):437–439CrossRefPubMed

25.

Ikeda K, Fritscher-Ravens A, Mosse CA, Mills T, Tajiri H, Swain CP (2005) Endoscopic full-thickness resection with sutured closure in a porcine model. Gastrointest Endosc 62(1):122–129CrossRefPubMed

26.

Shi Q, Chen T, Zhong YS, Zhou PH, Ren Z, Xu MD, Yao LQ (2013) Complete closure of large gastric defects after endoscopic full-thickness resection, using endoloop and metallic clip interrupted suture. Endoscopy 45(5):329–334CrossRefPubMed

27.

Huang LY, Cui J, Wu CR, Zhang B, Jiang LX, Xian XS, Lin SJ, Xu N, Cao XL, Wang ZH (2014) Endoscopic full-thickness resection and laparoscopic surgery for treatment of gastric stromal tumors. World J Gastroenterol 20(5):8253–8259CrossRefPubMedPubMedCentral

28.

Inoue H, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Eleftheriadis N, Maselli R, Kudo S (2012) Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 44(33):225–230PubMed

29.

Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75(1):195–199CrossRefPubMed

30.

Wang L, Ren W, Zhang Z, Yu J, Li Y, Song Y (2013) Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma. Surg Endosc 27(11):4259–4266CrossRefPubMed

31.

Lu J, Jiao T, Zheng M, Lu X (2014) Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection. Surg Endosc 28(12):3401–3407CrossRefPubMed

32.

Tan Y, Lv L, Duan T, Zhou J, Peng D, Tang Y, Liu D (2016) Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer. Surg Endosc 30(7):3121–3127CrossRefPubMed

33.

Liu BR, Song JT (2016) Submucosal tunneling endoscopic resection (STER) and other novel applications of submucosal tunneling in humans. Gastrointest Endosc Clin N Am 26(2):271–282CrossRefPubMed

Title: Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer
Authors: Yuyong Tan
Xiaoyu Tang
Ting Guo
Dongzi Peng
Yao Tang
Tianying Duan
Xuehong Wang
Liang Lv
Jirong Huo
Deliang Liu
Publication date: 01-08-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5350-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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