No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors

Tao Chen; Yun-Wei Zhang; Jing-Jing Lian; Hai-Bin Zhang; Ai-Ping Xu; Fang Li; Xiao-Han Yan; Ben-Song Duan; Zi-Ying Zhao; Yuan Chu; Li Shen; Jia Cao; Li Zhang; Liang Zheng; Shu-Guang Chu; Mei-Dong Xu

doi:10.1055/a-2013-1902

Endoscopy, Table of Contents

Endoscopy 2023; 55(06): 557-562
DOI: 10.1055/a-2013-1902

Innovations and brief communications

No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors

Tao Chen‡^‡

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Yun-Wei Zhang‡^‡

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Jing-Jing Lian

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Hai-Bin Zhang

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Ai-Ping Xu

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Fang Li

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Xiao-Han Yan

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Ben-Song Duan

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Zi-Ying Zhao

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Yuan Chu

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Li Shen

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Jia Cao

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Li Zhang

²Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Liang Zheng

³Research Center for Translation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Shu-Guang Chu

⁴Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

,

Mei-Dong Xu

¹Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

› Author Affiliations

Abstract

Background There remain concerns regarding the technical feasibility of endoscopic resection for large gastrointestinal stromal tumors (GISTs), mainly relating to the risk of tumor rupture and the adequacy of the resection margins. This study aimed to evaluate the feasibility and therapeutic outcomes of the newly developed no-touch endoscopic full-thickness resection (NT-EFTR) technique for GISTs.

Methods In this retrospective study, 92 patients with gastric GISTs undergoing NT-EFTR were included. Clinicopathological, endoscopic, and follow-up data were collected and analyzed.

Results The median tumor size was 2.5 cm and en bloc resection was achieved in all patients with negative surgical margins. The median time of the NT-EFTR procedure was 59.5 minutes. Large tumors (> 3.0 cm), extraluminal tumor growth pattern, and large gastric defects were significant contributors to long operative times. Patients were discharged within 4 days postoperatively. During follow-up, all patients were free from local recurrence and distant metastasis.

Conclusions NT-EFTR was a feasible method for the resection of gastric GISTs and can be expected to achieve complete radical resection. Large tumors with extraluminal growth and large gastric defects impact procedural difficulty.

Full Text

References

References
1 Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet 2013; 382: 973e983
2 Casali PG, Abecassis N, Aro HT. et al. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29: iv68-iv78
3 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
4 Koh YX, Chok AY, Zheng HL. et al. A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach. Ann Surg Oncol 2013; 20: 3549-3560
5 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
6 Chen T, Zhou PH, Chu Y. et al. Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg 2017; 265: 363-369
7 Chen T, Lin ZW, Zhang YQ. et al. Submucosal tunneling endoscopic resection vs thoracoscopic enucleation for large submucosal tumors in the esophagus and the esophagogastric junction. J Am Coll Surg 2017; 225: 806-816
8 Chen T, Wang GX, Lian JJ. et al. Submucosal tunneling endoscopic resection for submucosal tumors in the proximal esophagus. J Am Coll Surg 2022; 234: 1127-1135
9 Xu M, Wang XY, Zhou PH. et al. Endoscopic full-thickness resection of colonic submucosal tumors originating from the muscularis propria: an evolving therapeutic strategy. Endoscopy 2013; 45: 770-773
10 Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008; 39: 1411-1419

Supplementary Material

Supplementary material