Effect of endoscopic full-thickness resection assisted by distal serosal turnover with floss traction for gastric submucosal masses

BACKGROUND Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection(EFTR).Successful perforation repair under endoscopy,thereby avoiding surgical intervention and postoperative complications such as peritonitis,are pivotal for effective EFTR.AIM To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors.METHODS A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted.The total operation time,tumor dissection time,wound closure time,intraoperative bleeding volume,length of hospital stay and incidence of complications were analyzed.RESULTS There were 93 patients,aged 55.1±12.1 years.Complete tumor resection was achieved in all cases,resulting in a 100% success rate.The average total operation time was 67.4±27.0 min,with tumor dissection taking 43.6±20.4 min.Wound closure times varied,with gastric body closure time of 24.5±14.1 min and gastric fundus closure time of 16.6±8.7 min,showing a significant difference(P<0.05).Intraoperative blood loss was 2.3±4.0 mL,and average length of hospital stay was 5.7±1.9 d.There was no secondary perforation after suturing in all cases.The incidence of delayed bleeding was 2.2%,and the incidence of abdominal infection was 3.2%.No patient required other surgical intervention during and after the operation.CONCLUSION Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss,making it a viable approach for gastric submucosal tumors.

Application of blunt dissection in ESD of a gastric submucosal tumor

We performed endoscopic submucosal dissection of a gastric fundus tumor.It was difficult to strip the tumor completely due to space limitation,and we used blunt dissection to remove the tumor quickly and safely.Firstly,the basal area of the 2.5 cm submucosal tumor located in the gastric fundus was cut open,and the mucosa was dissected.The tumor was difficult to peel,therefore,a snare was used and the tumor was pulled and tightened slightly.Short electronic coagulation was used during the procedure.The tumor was then bluntly dissected.This method ensured rapid and complete removal of the tumor.

Oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor

Gastric submucosal tumors(SMTs) less than 2 cm are generally considered benign neoplasms, and endoscopic observation is recommended, but SMTs over 2 cm, 40% of which are gastrointestinal stromal tumors(GISTs), have malignant potential. Although the Japanese Guidelines for GIST recommend partial surgical resection for GIST over 2 cm with malignant potential as well as en bloc large tissue sample to obtain appropriate and large specimens of SMTs, several reports have been published on tissue sampling of SMTs, such as with endoscopic ultrasound sound fine needle aspiration, submucosal tunneling bloc biopsy, and the combination of bite biopsy and endoscopic mucosal resection. Because a simpler, more accurate method is needed for appropriate treatment, we developed oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor(OMOB) approach. OMOB was simple and enabled us to obtain large samples under direct procedure view as well as allowed us to restore to original mucosa.

Enlarged accessory spleen presenting stomach submucosal tumor

A 62-year-old man presented with upper abdominal discomfort underwent upper gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a submucosal tumor (SMT) with homogenous echogenicity originated from extragastric organs. An abdominal contrast-enhanced computed tomography (CT) showed that the well-marginated ovoid mass, approximately 6 cm in diameter, enhanced homogenously to a similar degree as splenic parenchyma. 99mTechnetium sulfur colloid scintigraphy revealed the splenic nature of the mass. A diagnosis of accessory spleen mimicking gastric SMT was made. Subsequent follow-up was uneventful without performing splenectomy.

Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach

Inflammatory fibroid polyp(IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography(CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.

Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection:a propensity-score-matching analysis

Background:Endoscopic resection,including endoscopic submucosal dissection(ESD)and endoscopic full-thickness resection(EFR),was used to resect small gastric submucosal tumors(SMTs).Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs.This study aims to explore the safety and effectiveness of the method.Methods:This research performed a propensity-score-matching(PSM)analysis to compare ESD/EFR assisted by a snare combined with endoclips(ESD/EFR with snare traction)with conventional ESD/EFR for the resection of gastric SMTs.Comparisons were made between the two groups,including operative time,en bloc resection rate,perioperative complications,and operation-related costs.Results:A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study.PSM yielded 51 matched pairs.No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories.However,the ESD/EFR-with-snare-traction group had a shorter median operative time(39 vs 60 min,P=0.005)and lower rate of en bloc resection(88.2%vs 100%,P¼0.027).Conclusions:ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs,with no increases in perioperative complications and the costs of endoscopic surgical accessories.Therefore,the method seems an appropriate choice for the resection of gastric SMTs.