Endoscopy 2018; 50(12): 1180-1185
DOI: 10.1055/a-0625-6326
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Ligation-assisted endoscopic submucosal resection with apical mucosal incision to treat gastric subepithelial tumors originating from the muscularis propria

Dingguo Zhang
1   Department of Gastroenterology, Shenzhen People’s Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
,
Qiuling Lin
2   Department of General Practice, Shenzhen People’s Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
,
Ruiyue Shi
1   Department of Gastroenterology, Shenzhen People’s Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
,
Lisheng Wang
1   Department of Gastroenterology, Shenzhen People’s Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
,
Jun Yao
1   Department of Gastroenterology, Shenzhen People’s Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
,
Yanhui Tian
1   Department of Gastroenterology, Shenzhen People’s Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
› Author Affiliations
Further Information

Publication History

submitted 23 November 2017

accepted after revision 09 April 2018

Publication Date:
18 June 2018 (online)

Abstract

Background This study aimed to evaluate the clinical efficacy, safety, and feasibility of performing endoscopic submucosal resection with a ligation device (ESMR-L) after apical mucosal incision (AMI) for the treatment of gastric subepithelial tumors originating from the muscularis propria (SET-MPs).

Methods 14 patients with gastric SET-MPs were treated by ESMR-L with AMI between December 2016 and May 2017. The complete resection rate, operation duration, and postoperative complications were collected. All patients were followed for 2 – 6 months.

Results The complete resection rate was 100 %, the mean tumor size was 10.71 ± 3.45 mm (7 – 18 mm), and the median operative time was 18.5 minutes. Perforation occurred in four patients, with all lesions being completely repaired endoscopically. No delayed bleeding or peritoneal signs were observed. No residual lesions or recurrence were found during the follow-up period.

Conclusions AMI with ESMR-L appears to be an efficient and simple method for the histological diagnosis of gastric SET-MPs, but it carries a high perforation rate and cannot guarantee cure.

 
  • References

  • 1 ESMO/European Sarcoma Network Working Group. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25: iii21-iii26
  • 2 Abe S, Cui X, Saito Y. et al. Endoscopic resection and enucleation of gastric submucosal tumor facilitated by subsequent closure of incision using over-the-scope clip. Endoscopy 2015; 47: E153-E154
  • 3 Xu MD, Cai MY, Zhou PH. et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI Submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc 2012; 75: 195-199
  • 4 Zhou PH, Yao LQ, Qin XY. et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 2011; 25: 2926-2931
  • 5 Mekky MA, Yamao K, Sawaki A. et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc 2010; 71: 913-919
  • 6 Binmoeller KF, Shah JN, Bhat YM. et al. Suck-ligate-unroof-biopsy by using a detachable 20 mm loop for the diagnosis and therapy of small subepithelial tumors. Gastrointest Endosc 2014; 79: 750-755
  • 7 Lee CK, Chung IK, Lee SH. et al. Endoscopic partial resection with the unroofing technique for reliable tissue diagnosis of upper GI subepithelial tumors originating from the muscularis propria on EUS. Gastrointest Endosc 2010; 71: 188-194
  • 8 Shimamura Y, Hwang J, Cirocco M. et al. Efficacy of single-incision needle-knife biopsy for sampling subepithelial lesions. Endosc Int Open 2017; 5: E5-E10
  • 9 Guo J, Liu Z, Sun S. et al. Ligation-assisted endoscopic enucleation for the diagnosis and resection of small gastrointestinal tumors originating from the muscularis propria: a preliminary study. BMC Gastroenterology 2013; 13: 88
  • 10 Cai MY, Zhou PH, Yao LQ. Current status of endoscopic resection in China. Dig Endosc 2012; 24: 166-171
  • 11 Zheng Z, Jiao G, Wang T. et al. Ligation-assisted endoscopic enucleation for the resection of gastrointestinal tumors originating from the muscularis propria: analysis of efficacy and facility. Dig Surg 2016; 33: 488-494
  • 12 Binmoeller KF, Shah JN, Bhat YM. et al. Retract-ligate-unroof-biopsy: a novel approach to the diagnosis and therapy of large nonpedunculated stromal tumors (with video). Gastrointest Endosc 2013; 77: 803-808
  • 13 Andalib I, Yeoun D, Reddy R. et al. Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data. Surg Endosc 2018; 32: 1787-1792
  • 14 Yague AS, Shah JN, Nguyentang T. et al. Simplified treatment of gastric GISTs by endolooping without resection: “loop-and-let-go”. Gastrointest Endosc 2009; 69: AB174-AB175
  • 15 Zhang SL, Zhao SG, Wang XX. et al. [Perforation after endoscopic ligation for stomach polypus: a case report.]. Chin J Endosc 2005; 11: 333