Comments on “No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors”

We read with great interest the article by Chen et al. [1] reporting the efficacy and safety of the no-touch endoscopic full-thickness resection (NT-EFTR) technique for gastric gastrointestinal stromal tumors (GISTs). We agree that this new method is useful for the resection of gastric GISTs. However, we have several questions about the study.

First, one aspect that made it inconvenient to remove larger tumors under endoscopy was the inability to retrieve them intact through the endoscope. In this study, tumors with a transverse diameter larger than 3.5 cm were divided into two pieces and retrieved, which goes against the principle of not damaging the tumor and maintaining its integrity, especially for GISTs with malignant potential, as disrupting their integrity might increase the risk of metastasis [2].

Second, the author mentioned preoperative ultrasound examination in the methods section to evaluate tumor origin and internal echogenicity, but no information about tumor origin was found in the results section. This information is particularly important when deciding whether or not to perform a full-thickness resection. According to the authors’ introduction, we understood that NT-EFTR was particularly suitable for extraluminal tumors; however, the cases included in the study mainly consisted of intraluminal growing tumors. It is questionable whether full-thickness resection was appropriate for such tumors. For intraluminal submucosal tumors in the stomach, endoscopic submucosal excavation might be more advisable, and the integrity of the digestive tract should be preserved [3].

Third, in the results section, the diameter of the gastric wall defect was significantly smaller than the tumor diameter. Why was that?

In general, even though this study had some shortcomings, NT-EFTR remained a useful method for gastric GISTs, especially those with extraluminal growth.

Publication History

Article published online:
21 December 2023

• References

• 1 Chen T, Zhang YW, Lian JJ. et al. No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors. Endoscopy 2023; 55: 557-562
• 2 Li J, Ye Y, Wang J. et al. Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor. Chin J Cancer Res 2017; 29: 281-293
• 3 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; 54: 412-429