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Kahaleh M, Bhagat V, Dellatore P, Tyberg A, Sarkar A, Shahid HM, Andalib I, Alkhiari R, Gaidhane M, Kedia P, Nieto J, Kumta NA, Dixon RE, Salameh H, Mavrogenis G, Bassioukas S, Abe S, Arentes VN, Morita FH, Sakai P, de Moura EG. Subepithelial tumors: How does endoscopic full-thickness resection & submucosal tunneling with endoscopic resection compare with laparoscopic endoscopic cooperative surgery? Endosc Int Open 2022; 10:E1491-E1496. [PMID: 36397865 PMCID: PMC9666078 DOI: 10.1055/a-1922-7890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
Background and study aims Endoscopic techniques are rapidly emerging for resection of subepithelial tumors (SETs). Submucosal tunneling for endoscopic resection (STER), endoscopic full-thickness resection (EFTR) and laparoscopic endoscopic cooperative surgery (LECS) are current alternatives to open surgery. In this study, we aimed to compare the three endoscopic techniques. Patients and methods Consecutive patients who underwent resection of a submucosal esophageal or gastric lesion at several tertiary care centers were included in a dedicated registry over 3 years. Demographics, size and location of resected lesion, histology of specimen, length of procedure, adverse events (AEs), duration of hospital stay, and follow-up data were collected. Results Ninety-six patients were included (47.7 % male, mean age 62): STER n = 34, EFTR n = 34, LECS n = 280. The lesions included leiomyoma, gastrointestinal stromal tumors (GISTs) and other. The mean lesion size was 28 mm (STD 16, range 20-72 mm). The majority of lesions in the EFTR and laparoscopic-assisted resection group were GISTs. There was no significant difference in clear resection margins, post-procedure complication rates, recurrence rate and total follow-up duration between the groups. However, the LECS group had a procedure time at least 30 minutes longer than STER or EFTR ( P < 0.01). Total hospital stay for the laparoscopic-assisted resection group was also longer when compared to STER (1.5) and EFTR (1.8) ( P < 0.01). Conclusions STER, EFTR, and laparoscopic-assisted resection are efficacious approaches for resection of SETs with similar R0 resection rates, complication rates, and AE rates. Laparoscopic assisted resection appears more time-consuming and is associated with a longer hospital stay.
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Affiliation(s)
- Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Vicky Bhagat
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Peter Dellatore
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Haroon M. Shahid
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Iman Andalib
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Resheed Alkhiari
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Prashant Kedia
- Gastroenterology, Methodist Hospital, Dallas, Texas, United States
| | - Jose Nieto
- Borland-Groover Clinic, Jacksonville, Florida, United States
| | - Nikhil A. Kumta
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Rebekah E. Dixon
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Habeeb Salameh
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | | | | | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Flavio H. Morita
- Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Sakai
- Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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