scholarly journals Optimal Endoscopic Resection Technique for Selected Gastric GISTs. The Endoscopic Suturing System Combined with ESD—a New Alternative?

2020 ◽  
Vol 9 (6) ◽  
pp. 1776
Author(s):  
Katarzyna M. Pawlak ◽  
Artur Raiter ◽  
Katarzyna Kozłowska-Petriczko ◽  
Joanna Szełemej ◽  
Jan Petriczko ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Therapeutic Option ◽  
Gastric Wall ◽  
Gastric Body ◽  
R0 Resection ◽  
Full Thickness ◽  
Therapeutic Success ◽  
Gastric Gists ◽  
Type Iii ◽  
Gastrointestinal Lesions

Background and Study Aim: In terms of therapeutic management, gastrointestinal stromal tumors (GISTs) seem to be the most difficult group of subepithelial gastrointestinal lesions (SELs). Despite various treatment option, choice of optimal management remains a dilemma in daily practice. Our aim was to evaluate a new hybrid resection technique of gastric GISTs type III as a modality of endoscopic full-thickness resection. Methods: Three males and one female (mean age of 68) were qualified for the procedure. Endoscopic full-thickness resections consisted of the endoscopic resection combined with suturing by Apollo OverStitch System. The main inclusion criterium was a complete diagnosis of GISTs (computed tomography (CT), endoscopic ultrasound (EUS), fine-needle biopsy (FNB)) with the evaluation of the tumor features, especially, the location in the gastric wall. All of the tumors were type III with a diameter between 20–40 mm. The lesions were located in the corpus (1), antrum (1) and between gastric body and fundus (2). All procedures were performed in 2019. Results: The technical and therapeutic success rate was 100% and the mean resection time 107.5 min. Neither intra- nor postprocedural complications were observed. In all four cases, R0 resection was achieved. Histopathologic assessment confirmed GIST with <5mitose/50HPF in all of the tumors, with very low risk. Conclusion: Based on our outcomes, endoscopic resection combined with the sewing by Apollo OverStitch of gastric GISTs type III, with the diameter between 20–40 mm, seems to be an effective therapeutic option with a good safety profile, however further studies with a larger treatment group are needed.

scholarly journals On the Track of New Endoscopic Alternatives for the Treatment of Selected Gastric GISTs—A Pilot Study

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 625
Author(s):  
Artur Raiter ◽  
Katarzyna M. Pawlak ◽  
Katarzyna Kozłowska-Petriczko ◽  
Jan Petriczko ◽  
Joanna Szełemej ◽  
...  
Keyword(s):  
Pilot Study ◽  
Endoscopic Resection ◽  
Tumour Size ◽  
Gastric Wall ◽  
Muscularis Propria ◽  
R0 Resection ◽  
Hybrid Technique ◽  
Endoscopic Techniques ◽  
Gastric Gists ◽  
Type Iii

Background and Objectives: GISTs (Gastrointestinal stromal tumors) are the most common mesenchymal gastrointestinal tract tumours and are mainly located in the stomach. Their malignant potential depends on size, location, and type. Endoscopic techniques are a less invasive modality for patients not eligible for surgery. ESD (endoscopic submucosal dissection) is mainly used for the removal of smaller GISTs, with intraluminal growth and a more superficial location. Thus, R0 resection capability in some cases may be not sufficient, limited by tumour size, location in the gastric wall, and its connection level with the muscularis propria. In such cases, an endoscopic full-thickness resection can become a new alternative. In this retrospective pilot study, we evaluated ESD and hybrid resection techniques in terms of safety, efficacy, and disease recurrence for selected types of gastric GISTs. Materials and Methods: A retrospective comparison was conducted in a group of patients who underwent ESD or a hybrid technique combining endoscopic resection with endoscopic suturing using the OverStitch system (HT) for type II or III gastric GISTs. A total of 21 patients aged 70 ± 8 years underwent endoscopic resection. Seventeen lesions were treated with ESD and four with the HT. Results: R0 resection was achieved in all patients treated using HT (type III lesions) and in 53% of those treated with ESD (p = 0.08). None of the type III lesions treated with ESD were excised with R0. Lesions treated with R0 ESD resections were significantly smaller (1.76 ± 0.35 cm) than those with R1 ESD resections (2.39 ± 0.40 cm) (p < 0.01). The mean lesion size treated with the HT was 2.88 ± 0.85 cm. Conclusions: HT may be a new resection modality for large gastric GISTs with high muscularis propria connection grades. Further studies are required to evaluate its safety and efficacy and to form precise inclusion criteria for endoscopic resection techniques.

scholarly journals Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Field F. Willingham ◽  
Paul Reynolds ◽  
Melinda Lewis ◽  
Andrew Ross ◽  
Shishir K. Maithel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Wedge Resection ◽  
Tertiary Care ◽  
R0 Resection ◽  
Full Thickness ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Deep Margin

Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors.Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management.Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens.Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.

scholarly journals Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis

2020 ◽  
Vol 08 (03) ◽  
pp. E313-E325 ◽  
Author(s):  
Olaya I. Brewer Gutierrez ◽  
Venkata S. Akshintala ◽  
Yervant Ichkhanian ◽  
Gala G. Brewer ◽  
Yuri Hanada ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Resection ◽  
Meta Analysis ◽  
R0 Resection ◽  
Full Thickness ◽  
Resection Rate ◽  
Gastrointestinal Lesions ◽  
Endoscopic Full Thickness Resection ◽  
Epithelial Lesions ◽  
Enbloc Resection

Abstract Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors. Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots. Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n = 634), colorectal SELs (n = 42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n = 6). Median size of lesions was 13.5 mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82 % (95 % CI: 75, 89). The pooled overall FTR rate was 83 % (95 % CI: 77, 89). The pooled overall enbloc resection rate was 95 (95 % CI: 92, 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7 % (95 % 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 % and < 0.1 %, respectively. No mortality related to EFTR was noted. Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases.

Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection

2021 ◽  
pp. 1-14
Author(s):  
Arthur Hoffman ◽  
Raja Atreya ◽  
Timo Rath ◽  
Markus Ferdinand Neurath
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
Complication Rates ◽  
Full Thickness ◽  
National Guidelines ◽  
En Bloc ◽  
Early Stages ◽  
Mucosal Resection ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Background:</i></b> Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4–1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. <b><i>Summary:</i></b> Endoscopic treatment is now regarded as first-line therapy for benign lesions. <b><i>Key Message:</i></b> Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.

scholarly journals Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: the first international experience

2020 ◽  
Vol 08 (10) ◽  
pp. E1291-E1301
Author(s):  
Mouen A. Khashab ◽  
Reem Z. Sharaiha ◽  
Kaveh Hajifathalian ◽  
Yervant Ichkhanian ◽  
Qais Dawod ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Resection ◽  
Early Recurrence ◽  
Endoscopic Examination ◽  
Upper Gastrointestinal Tract ◽  
R0 Resection ◽  
Full Thickness ◽  
Technical Success Rate ◽  
Average Size ◽  
Upper Gastrointestinal

Abstract Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68–138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.

scholarly journals Resection of a Nonampullary Adenoma with the New Gastroduodenal Full-Thickness Resection Device

2020 ◽  
Vol 11 (03) ◽  
pp. 242-244
Author(s):  
Maximilian Gericke ◽  
Matthias Mende ◽  
Dirk Hartmann ◽  
Siegbert Faiss
Keyword(s):  
Gastrointestinal Tract ◽  
Surgical Resection ◽  
Endoscopic Resection ◽  
Significant Risk ◽  
R0 Resection ◽  
High Morbidity ◽  
Full Thickness ◽  
Endoscopic Full Thickness Resection ◽  
Upper Gastrointestinal ◽  
Subepithelial Tumors

Abstract Introduction Surgical resection of adenomas or subepithelial tumors in the duodenum has a high morbidity compared with endoscopic resection which also has a significant risk of complication. Endoscopic full-thickness resection has shown its feasibility and safety in the colorectum and in the upper gastrointestinal tract. Patient and Methods We present the new gastroduodenal full-thickness resection device (FTRD) for full-thickness resection in a patient with a recurrent nonlifting adenoma in the nonampullary duodenum. Results The procedure was successful with R0 resection without major complications. A control gastroscopy showed no recurrence of the adenoma. Conclusion The gastroduodenal FTRD seems to be a promising new technique for resecting nonlifting adenomas in the nonampullary duodenum.

scholarly journals Endoscopic full-thickness resection of early colorectal neoplasms using an endoscopic submucosal dissection knife: a retrospective multicenter study

2020 ◽  
Vol 08 (05) ◽  
pp. E611-E616 ◽  
Author(s):  
Marie-Anne Guillaumot ◽  
Maximilien Barret ◽  
Jérémie Jacques ◽  
Romain Legros ◽  
Mathieu Pioche ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
Endoscopic Resection ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Gastrointestinal Neoplasms ◽  
R0 Resection ◽  
Full Thickness ◽  
Submucosal Dissection ◽  
Endoscopic Full Thickness Resection

Abstract Background and study aims Endoscopic full-thickness resection allows resection of early gastrointestinal neoplasms not amenable to conventional endoscopic resection techniques, due to their location, presence of submucosal fibrosis, or suspected deep mural invasion. It is typically achieved using a dedicated over-the-scope device (full-thickness resection device or FTRD). The aim of our study was to evaluate the feasibility, safety, and clinical outcomes of endoscopic full-thickness resection using an endoscopic submucosal dissection (ESD) knife. Patients and methods Consecutive patients who underwent full-thickness endoscopic resection at six tertiary care centers from August 2010 to June 2017 were retrospectively included. We conducted a comparative analysis of patient characteristics, technical success, adverse events, and time to discharge between patients treated by a full-thickness resection using an ESD knife. Results Twenty-one procedures were performed using an ESD knife. En-bloc resection and R0 resection rates were 95.2 % and 65 %, respectively. Clinical symptoms of perforation occurred in 66.7 %. There was no need for surgery or additional endoscopic procedures. Conclusion Endoscopic full-thickness resection of early colorectal neoplasms using an ESD knife might be feasible and safe. It allows complete resection of lesions with no limitation in size. The technique may be preferable to an other-the-scope resection device in lesions larger than 20 mm, and to surgery in selected cases of low-risk T1 colorectal carcinomas, non-lifting adenomas, submucosal tumors, or technically challenging lesion locations.

scholarly journals Over-the-scope clip-assisted endoscopic full-thickness resection has potential to treat complex nonampullary duodenal lesions: a single-center case series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yongqiu Wei ◽  
Qiaozhi Zhou ◽  
Ming Ji ◽  
Shutian Zhang ◽  
Peng Li
Keyword(s):  
Endoscopic Resection ◽  
Case Series ◽  
Muscularis Propria ◽  
Complete Resection ◽  
R0 Resection ◽  
Full Thickness ◽  
Retrospective Case ◽  
Duodenal Lesions ◽  
Endoscopic Full Thickness Resection ◽  
Over The Scope Clip

Abstract Background and aims The duodenum is considered a challenging area for the endoscopic resection of lesions. This study aimed to evaluate the efficacy and safety of over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) for complex nonampullary duodenal lesions unsuitable for conventional resection techniques. Methods and patients We conducted a retrospective case review of 13 consecutive patients with complex nonampullary duodenal tumors that were unsuitable for conventional resection techniques; these patients underwent EFTR assisted with OTSC at Beijing Friendship Hospital, Capital Medical University from September 2015 to September 2020. The OTSC device was placed, and tumors were resected after the lesions were identified. Data were abstracted for demographics, lesion features, histopathologic diagnoses, technical success rates, complete resection (R0 resection) rates, and complications. Results Thirteen patients with duodenal lesions (6 adenomas and 7 submucosal tumors with nonlifting signs, incomplete lifting signs, difficult locations, failed ESD/EMR attempts or suspected origin in the muscularis propria) subjected to EFTR were included. The sizes of all the lesions evaluated by endoscopy were smaller than 20 mm, and most of them (84.6%, 11/13) were smaller than 12 mm. All 13 applications of the clips, endoscopic resection and full-thickness resection were successful (13/13, 100%). Complete resection was achieved in 12 patients (12/13, 92.3%). There were no immediate or delayed complications, including bleeding, infection and perforation. Conclusions OTSC -assisted EFTR appears to be effective and safe for complex nonampullary duodenal lesions smaller than 20 mm (particularly those ≤ 10–12 mm) that are unsuitable for conventional resection techniques.

ENDOSCOPIC RESECTION OF A GASTRIC SUBMUCOSAL HEMANGIOMA USING A FULL-THICKNESS RESECTION DEVICE

2020 ◽  
Author(s):  
Á Terán ◽  
M Pascual ◽  
PL Fernández-Gil ◽  
M Moris ◽  
CD Pozo ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Full Thickness

scholarly journals Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile

2021 ◽  
pp. 1-9
Author(s):  
João Santos-Antunes ◽  
Margarida Marques ◽  
Rui Morais ◽  
Fátima Carneiro ◽  
Guilherme Macedo
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Safety Profile ◽  
En Bloc Resection ◽  
R0 Resection ◽  
Hybrid Technique ◽  
Resection Rate ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Introduction:</i></b> Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. <b><i>Methods:</i></b> We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. <b><i>Results:</i></b> Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (<i>n</i> = 24) and rectum (<i>n</i> = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). <b><i>Conclusion:</i></b> Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.

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