Endoscopic full-thickness resection of gastric stromal tumor arising from the muscularis propria

Endoscopic semi-blunt dissection technique is safe and effective for treating gastric submucosal tumors from the muscularis propria

BACKGROUND

Needle knives are the most commonly used instrument during endoscopic treatment for gastric submucosal tumors (SMTs). The conventional resection method involves fully extending the needle-shaped knife head, which allows it to more easily penetrate the muscularis propria while stripping the muscle layer of the tumor. We propose a semi-blunt dissection method that can effectively reduce damage to the muscularis propria.

METHODS

A total of 113 patients who underwent endoscopic resection of gastric SMTs originating from the muscularis propria were retrospectively analyzed. The conventional method consisted of 73 patients; The other group consisted of 40 patients underwent the semi-blunt dissection method.

RESULTS

There was no significant difference between the two groups in age, sex, or lesion location. The intraoperative operational variable, the maximum diameter of gastric muscularis propria damage, was significantly greater in conventional method group than the other group (1.06 ± 0.48 cm vs. 0.46 ± 0.09 cm, p < 0.001). There was also no significant difference between the two groups in terms of histological diagnosis, postoperative complications and the percentage of histologically positive resection margins.

CONCLUSION

The semi-blunt dissection method has certain advantages in the endoscopic resection of gastric tumors originating from the muscularis propria, including a small extent of gastric muscularis propria damage and a shorter postoperative hospital stay.

Endoscopic full-thickness resection: Current status

Conventional endoscopic resection techniques such as endoscopic mucosal resection or endoscopic submucosal dissection are powerful tools for treatment of gastrointestinal neoplasms. However, those techniques are restricted to superficial layers of the gastrointestinal wall. Endoscopic full-thickness resection (EFTR) is an evolving technique, which is just about to enter clinical routine. It is not only a powerful tool for diagnostic tissue acquisition but also has the potential to spare surgical therapy in selected patients. This review will give an overview about current EFTR techniques and devices.