Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review

Abstract

Background and study aims Exposed endoscopic full-thickness resection (Eo-EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery (NOTES) technique that has shown promising efficacy and safety in resection of gastric submucosal tumors (G-SMTs) arising from muscularis propria (MP). However, data on the efficacy and safety of gastric Eo-EFTR mostly come from relatively small retrospective studies and concern regarding its use still exists. The aim of our systematic review was to assess the efficacy and safety of gastric Eo-EFTR without laparoscopic assistance.

Methods A detailed MEDLINE and EMBASE search was performed for papers published from January 1998 to November 2019 and reporting on gastric Eo-EFTR without laparoscopic assistance. The search strategy used the terms “endoscopic full thickness resection” and “gastric” or “stomach”. The primary outcomes were complete resection and surgical conversion rates. The secondary outcomes were overall major adverse events, delayed bleeding, delayed perforation, peritonitis, abdominal abscess and/or abdominal infection and successful Eo-EFTR.

Results Fifteen Asian studies were included in our final review, providing data on 750 Eo-EFTR-treated G-SMTs. The per-lesion rate of complete resection and surgical conversion were 98.8 %\0.8 %, respectively. The per-lesion rate of major adverse events, delayed bleeding, delayed perforation and peritonitis, abdominal abscess and/or abdominal infection was 1.6 %\0.5 %\0.1 %\0.9 %, respectively. The per-lesion rate of successful Eo-EFTR (i. e. complete tumor resection and effective endoscopic defect closure) was 98.3 %.

Conclusions Eo-EFTR without laparoscopic assistance appears to be highly effective and safe NOTES for removing deep G-SMTs, particularly those arising from MP layer.

Publication History

Received: 05 February 2020

Accepted: 25 May 2020

Article published online:
31 August 2020

• References

• 1 von Mehren M, Randall RL, Benjamin RS. et al. Soft Tissue Sarcoma, Version 2. 2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018; 16: 536-563
• 2 Cai M, Zhou P, Lourenço LC. et al. Endoscopic full-thickness resection (EFTR) for gastrointestinal subepithelial tumors. Gastrointest Endosc Clin N Am 2016; 26: 283-295
• 3 Jain D, Mahmood E, Desai A. et al. Endoscopic full thickness resection for gastric tumors originating from muscularis propria. World J Gastrointest Endosc 2016; 8: 489-495
• 4 Cai MY, Martin Carreras-Presas F, Zhou PH. Endoscopic full-thickness resection for gastrointestinal submucosal tumors. Dig Endosc 2018; 30: 17-24
• 5 Mori H, Kobara H, Nishiyama N. et al. Current status and future perspectives of endoscopic full-thickness resection. Dig Endosc 2018; 30: 25-31
• 6 Zhang X, Modayil R, Criscitelli T. et al. Endoscopic resection for subepithelial lesions-pure endoscopic full-thickness resection and submucosal tunneling endoscopic resection. Transl Gastroenterol Hepatol 2019; 4: 39
• 7 Suzuki H, Okuwaki S, Ikeda K. et al. Endoscopic full-thickness resection (EFTR) and waterproof defect closure (ENDC) for improvement of curability and safety in endoscopic treatment of early gastrointestinal malignancies (in Japanese, English abstract). Prog Dig Endosc 1998; 52: 49-53
• 8 Suzuki H, Ikeda K. Endoscopic mucosal resection and full thickness resection with complete defect closure for early gastrointestinal malignancies. Endoscopy 2001; 33: 437-439
• 9 Ikeda K, Mosse CA, Park PO. et al. Endoscopic full-thickness resection: circumferential cutting method. Gastrointest Endosc 2006; 64: 82-89
• 10 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
• 11 Shi Q, Chen T, Zhong YS. et al. Complete closure of large gastric defects after endoscopic fullthickness resection, using endoloop and metallic clip interrupted suture. Endoscopy 2013; 45: 329-334
• 12 Ye LP, Yu Z, Mao XL. et al. Endoscopic fullthickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc 2014; 28: 1978-1983
• 13 Guo J, Liu Z, Sun S. et al. Endoscopic full-thickness resection with defect closure using an over-the-scope clip for gastric subepithelial tumors originating from the muscularis propria. Surg Endosc 2015; 29: 3356-3362
• 14 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
• 15 Azzolini F, Cecinato P, Iori V. et al. Endoscopic full-thickness resection for suspected residual rectal neuroendocrine tumor and closure of the defect with a new suturing system. Endoscopy 2015; 47: E556-E557
• 16 Xu MM, Angeles A, Kahaleh M. Endoscopic full-thickness resection of gastric stromal tumor: one and done. Endoscopy 2018; 50: E42-E43
• 17 Granata A, Bisello M, Cipolletta F. et al. Endoscopic wedge gastrectomy of a gastric subepithelial tumor and closure of the gastric wall defect with the overstitch suturing system. Surg Innov 2018; 25: 542-543
• 18 Granata A, Amata M, Ligresti D. et al. Underwater full-thickness resection of a duodenal bulb gastrointestinal stromal tumor with OverStitch defect repair. Endoscopy 2019; 51: E207-E208
• 19 Dedania B, Mistry T, Buryanek J. et al. Endoscopic full-thickness resection of a gastric subepithelial tumor. VideoGIE 2018; 3: 79-80
• 20 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009; 151: 65-94
• 21 Wells GA, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010 http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (Accessed 2020 Apr 6)
• 22 Feng Y, Yu L, Yang S. et al. Endolumenal endoscopic full-thickness resection of muscularis propria-originating gastric submucosal tumors. J Laparoendosc Adv Surg Tech A 2014; 24: 171-176
• 23 Dong HY, Wang YL, Jia XY. et al. Modified laparoscopic intragastric surgery and endoscopic full-thickness resection for gastric stromal tumor originating from the muscularis propria. Surg Endosc 2014; 28: 1447-1453
• 24 Wu CR, Huang LY, Guo J. et al. Clinical Control Study of Endoscopic Full-thickness Resection and Laparoscopic Surgery in the Treatment of Gastric Tumors Arising from the Muscularis Propria. Chin Med J (Engl) 2015; 128: 1455-1459
• 25 Yang F, Wang S, Sun S. et al. Factors associated with endoscopic full-thickness resection of gastric submucosal tumors. Surg Endosc 2015; 29: 3588-3593
• 26 Lu J, Jiao T, Li Y. et al. Facilitating retroflexed endoscopic full-thickness resection through loop-mediated or rope-mediated countertraction (with videos). Gastrointest Endosc 2016; 83: 223-228
• 27 Shi D, Li R, Chen W. et al. Application of novel endoloops to close the defects resulted from endoscopic full-thickness resection with single-channel gastroscope: a multicenter study. Surg Endosc 2017; 31: 837-842
• 28 Hu JW, Ge L, Zhou PH. et al. A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video). Surg Endosc 2017; 31: 4275-4282
• 29 Sun M, Song J, Song X. et al. Endoscopic full-thickness resection for gastric subepithelial tumors originating from the muscularis propria: a 69-case series. Surg Laparosc Endosc Percutan Tech 2018; 28: e12-e17
• 30 Abe N, Takeuchi H, Ohki A. et al. Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor. Dig Endosc 2018; 30 (Suppl. 01) 7-16
• 31 Wu N, Liu S, Chen M. et al. The prepurse-string suture technique for gastric defect after endoscopic full-thickness resection (with video). Medicine (Baltimore) 2018; 97: e12118
• 32 Zhang H, Huang X, Qu C. et al. Comparison between laparoscopic and endoscopic resections for gastric submucosal tumors. Saudi J Gastroenterol 2019; 25: 245-250
• 33 Li B, Shi Q, Qi ZP. et al. The efficacy of dental floss and a hemoclip as a traction method for the endoscopic full-thickness resection of submucosal tumors in the gastric fundus. Surg Endosc 2019; 33: 3864-3873