Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from muscularis propria layer

Abstract

Objective To evaluate the feasibility and efficacy of endoscopic full-thickness resection （EFR） without laparoscopic assistance for gastric submucosal tumors （SMTs） originated from muscularis propria layer. Methods A total of 20 cases of gastric SMT, originated from muscularis propria, was resected by EFR from July 2007 to August 2009. EFR consisted of five major procedures, including normal saline injection into the submncosa and pre-cut of the mucosal and submucosal layer around the lesion, circumferential incision as deep as muscularis propria around the lesion with endoscopic submucosal dissection （ESD） , incision into serosal layer around the lesion with a Hook knife, full-thickness recection of the tumor including the serosal layer with Hook, IT, or snare on gastroscopy without laparoscopic assistance and closure of the gastric wall with metallic clips. Results Of 20 gastric SMTs, 9 located at the fundus, 11 at the corpus. EFR was successfully performed in all 20 patients without laparoscopic assistance. The complete resection rate was 100% , and the mean operation time was 85 min （60-145 min）. The mean tumor size was 2. 6 cm （ 1.8-3.5 cm）. Pathological examination confirmed gastrointestinal stromal tumors （GISTs） in 13 cases, leiomyoma in 4, glomus tumor in 2 and Schwannoma in 1 patient. No gastric bleeding, peritonitis or abdominal abscess occurred after EFR. Post-operative contrast roentgenography on the third day detected no contrast extravasation into abdominal cavity or disturbance of gastric emptying in any patients. The mean hospitalization time was 5.5 d （3-8 days）. The mean follow-up period was 7 months （ 1-12 months） with no lesion residue or recurrence. Conclusion EFR, efficacious, safe, and minimally invasive for patients with gastric SMTs originated from muscularis propria layer, is able to resect deep gastric lesion and provide precise path- ological information about the lesion. With the development of EFR, the indication of endoscopic resection might be extended. Key words: Endoscopic surgical procedures; Stomach; Submucosal tumor; Endoscopic fullthickness resection