Reply to Qin and Linghu

We thank Drs Qin and Linghu for their comments on our study, which applied a grasp-and-snare technique followed by over-the-scope clip (OTSC) closure for endoscopic resection of small gastric subepithelial tumors (SETs) [1].

In our study, we did not experience any problems in detecting tumors before resection. However, we agree that endoscopic submucosal dissection (ESD) is a good treatment option for SETs, but think that in order to achieve complete resection ESD is mostly limited to SETs that do not involve the muscularis propria layer. If complete resection of tumors arising from the muscularis propria is performed, perforation with potential contamination of the peritoneal cavity is as inevitable as with the grasp-and-snare technique. Furthermore, ESD – even in expert hands – remains a very time-consuming method.

Finally, in our study, in which the maximum tumor size was 3 cm, we achieved 100 % closure of all leaks including all gastric perforations. We agree that the OTSC is not able to close larger leaks. However, even for larger tumors (≤ 3 cm in diameter) the size of perforation is usually smaller than 1 – 2 cm given that only the base of the tumor is grasped by the snare, and application of a single OTSC is usually sufficient. We agree that for larger tumors (> 3 cm) with a higher malignant potential our technique is not feasible. We would still recommend surgery in these cases.

• References

• 1 Schlag C, Wilhelm D, Delius SV et al. EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy 2013; 45: 4-11