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DOI: 10.1055/a-1972-3409
Endoscopic full-thickness resection (EFTR) compared to submucosal tunnel endoscopic resection (STER) for treatment of gastric gastrointestinal stromal tumors
Abstract
Background and study aims Submucosal tunnel endoscopic resection (STER) is being increasingly performed for treatment of gastric gastrointestinal stromal tumor (GIST), while STER has been limited by close dissection within tunnel and risking breach of tumor capsule. Endoscopic full-thickness resection (EFTR) allows resection of GIST with margins to prevent recurrence. This study aimed to compare EFTR against STER for treatment of gastric GIST.
Patients and methods We retrospectively reviewed clinical outcomes of patients with gastric GIST who received either STER or EFTR. Patients with gastric GISTs < than 4 cm were included. Clinical outcomes including baseline demographics, perioperative and oncological outcomes were compared between the two groups.
Results From 2013 to 2019, 46 patients with gastric GISTs were treated with endoscopic resection, 26 received EFTR and 20 received STER. Most of the GISTs were in the proximal stomach. There was no difference in operative time (94.9 vs 84.9 mins; P = 0.401), while endoscopic suturing was applied more for closure after EFTR (P < 0.0001). Patients after STER had earlier resumption of diet and shorter hospital stay while there was no difference in adverse event rate between two groups. The en-bloc resection rate for EFTR was significantly higher than for STER (100 % vs 80 %; P = 0.029), while there was no difference in the local recurrence.
Conclusions This study demonstrated that although patients who received EFTR had longer hospital stays and slower resumption of diet compared to those who underwent STER, EFTR achieved a significantly higher rate of en-bloc resection compared to STER for treatment of gastric GIST.
Publication History
Received: 28 March 2022
Accepted after revision: 02 November 2022
Accepted Manuscript online:
04 November 2022
Article published online:
23 February 2023
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Casaku PG, Blay JY, Abecassis N. et al. Gastointestinal stromal tumors: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and followup. Ann Oncol 2022; 33: 20-33
- 2 National Comprehensive Cancer Network Guidelines Gastrointestinal Stromal Tumors (GISTs) (Version 1.2022). https://www.nccn.org/guidelines/recently-published-guidelines
- 3 Yang YT, Shen N, Ao F. et al. Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: a systematic review and meta-analysis. Surg Endosc 2020; 34: 3754-3765
- 4 Chiu PW, Teoh AY, To KF. et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc 2012; 26: 3584-3591
- 5 An W, Sun PB, Gao J. et al. Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surg Endosc 2017; 31: 4522-4531
- 6 Karaca C, Daglilar ES, Soyer OM. et al. Endoscopic submucosal resection of gastric subepithelial lesions smaller than 20 mm: a comparison of saline solution-assisted snare and cap band mucosectomy techniques. Gastrointest Endosc 2017; 85: 956-962
- 7 Tan Y, Tan L, Lu J. et al. Endoscopic resection of gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol 2017; 19: 115
- 8 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
- 9 Cho JW, Korean ESD Study Group. Current guidelines in the management of upper gastrointestinal subepithelial tumors. Clin Endosc 2016; 49: 235-240
- 10 Wang XY, Xu MD, Yao LQ. et al. Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos). Surg Endosc 2014; 28: 1971-1977
- 11 Chiu PW, Inoue H, Rösch T. From POEM to POET: Applications and perspectives for submucosal tunnel endoscopy. Endoscopy 2016; 48: 1134-1142
- 12 Ye LP, Zhang Y, Mao XL. et al. Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc 2014; 28: 524-530
- 13 Chen T, Zhang C, Yao LQ. et al. Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Endoscopy 2016; 48: 149-155
- 14 Aslanian HR, Sethi A. ASGE Technology Committee. et al. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 2019; 29: 343-350
- 15 Deprez PH, Moons LMG, OʼToole D. et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; DOI: 10.1055/a-1751-5742.
- 16 Chiu PWY, Yip HC, Teoh AYB. et al. Per oral endoscopic tumor (POET) resection for treatment of upper gastrointestinal subepithelial tumors. Surg Endosc 2019; 33: 1326-1333
- 17 Agaimy A, Wünsch PH, Hofstaedter F. et al. Minute gastric sclerosing stromal tumors (GIST tumorlets) are common in adults and frequently show c-KIT mutations. Am J Surg Pathol 2007; 31: 113-120
- 18 Trindade AJ, Benias PC, Alshelleh M. et al. Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: a large multicenter study. Endosc Int Open 2019; 7: E931-E936
- 19 Kushnir VM, Keswani RN, Hollander TG. et al. Compliance with surveillance recommendations for foregut subepithelial tumors is poor: results of a prospective multicenter study. Gastrointest Endosc 2015; 81: 1378-1384
- 20 Zhang XC, Li QL, Yu YF. et al. Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis. Surg Endosc 2016; 30: 2431-2441
- 21 Godat S, Robert M, Caillol F. et al. Efficiency and safety of endoscopic resection in the management of subepithelial lesions of the stomach. United Europ Gastroenterol J 2016; 4: 250-256
- 22 Du C, Chai N, Linghu E. et al. Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation. Surg Endosc 2018; 32: 4543-4551
- 23 Lu J, Jiao T, Zheng M. et al. Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection. Surg Endosc 2014; 28: 3401-3407
- 24 Zhang Q, Gao LQ, Han ZL. et al. Effectiveness and safety of endoscopic resection for gastric GISTs: a systematic review. Minim Invasive Ther Allied Technol 2018; 27: 127-137
- 25 Joo MK, Park JJ, Kim H. et al. Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract. Gastrointest Endosc 2016; 83: 318-326