Background and Aims
Endoscopic full-thickness resection (EFTR) is difficult to perform in a retroflexed
fashion in the gastric fundus and lesser curvature. Here we describe two simple methods
to provide countertraction and thereby facilitate dissection.
Methods
In this retrospective cohort study, 62 patients diagnosed as having gastric submucosal
tumors in the fundus or in the lesser curvature received EFTR with or without countertraction
methods. For the clip-with-thread method, a clip tied with surgical suture was anchored
on the distal edge of the tumor to provide countertraction; for the loop-assisted
method, a snare placed on the transparent cap beforehand was adopted to grasp the
tumor to provide countertraction.
Results
Mean operative time was significantly reduced in the thread-with-clip group and loop-assisted
group (45 minutes, 40 minutes, respectively) compared with the time needed in the
traditional EFTR group (85 minutes). Intraoperative pneumoperitoneum occurred regularly
among the 3 groups because of iatrogenic perforation, but fewer patients in the thread-with-clip
group and loop-assisted group (23%, 18%, respectively) needed abdominal puncture to
relieve free air and stabilize life signs compared with patients in the traditional
EFTR group (63%). A reduced occurrence of high fever after surgery may contribute
as another advantage from accelerated dissection. Both techniques did not jeopardize
oncologic safety during short-term follow-up.
Conclusions
Both the thread-with-clip method and loop-assisted method provide effective countertraction
and offer faster and safer gastric EFTR in difficult anatomic locations.
Abbreviations:
EFTR (endoscopic full-thickness resection), ESD (endoscopic submucosal dissection), IT (insulation tip), OTSC (over-the-scope clip), PPI (proton pump inhibitor), SMT (submucosal tumor)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria.Surg Endosc. 2011; 25: 2926-2931
- What we want for ESD is a second hand! Traction method.Gastrointest Endosc. 2013; 78: 274-276
- Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection.Surg Endosc. 2014; 28: 3401-3407
- Molecular pathobiology of gastrointestinal stromal sarcomas.Ann Rev Pathol. 2008; 3: 557-586
- Endoscopic management of upper gastrointestinal submucosal tumors arising from muscularis propria.J Clin Gastroenterol. 2014; 48: 667-673
- A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection.Gastrointest Endosc. 2009; 69: 29-33
- Endoscopic submucosal dissection for early gastric cancer using a cross-counter technique.Surg Endosc. 2012; 26: 3676-3681
- Endoscopic full-thickness resection for gastrointestinal lesions using the over-the-scope clip system: a case series.Endoscopy. 2015; 47: 76-79
- Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract.Endoscopy. 2014; 46: 758-761
- Endoscopic full-thickness biopsy of the gastric wall with defect closure by using an endoscopic suturing device: survival porcine study.Gastrointest Endosc. 2012; 76: 1014-1019
- Endoscopic full-thickness GI wall resection: current status.Gastrointest Endosc. 2012; 75: 165-173
- EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors.Endoscopy. 2013; 45: 4-11
- Gastric wall healing after NOTES procedures: closure with endoscopic clips provides superior histological outcome compared with threaded tags closure.Gastrointest Endosc. 2010; 72: 343-350
Article info
Publication history
Published online: September 10, 2015
Accepted:
August 7,
2015
Received:
April 18,
2015
Footnotes
DISCLOSURE: The study was supported by grant 2012AA021103 from the National High Technology Research and Development Program 863 and project grants from Qilu Hospital, Shandong University School of Medicine. All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr X. Lu at [email protected]
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
