Endoscopic mucosa-sparing lateral dissection for treatment of gastric submucosal tumors: a prospective cohort study

Endoscopy ◽  
2018 ◽  
Vol 50 (09) ◽  
pp. 886-890 ◽  
Author(s):  
Yue Li ◽  
Qiang Zhang ◽  
Chaojun Zhu ◽  
Yuchen Luo ◽  
Zelong Han ◽  
...  
Keyword(s):  
Large Scale ◽  
Muscularis Propria ◽  
En Bloc Resection ◽  
Clinicopathological Characteristics ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Tumors ◽  
Gastric Submucosal Tumors ◽  
Estimated Blood Loss ◽  
The Mean

Abstract Background In our previous work, we developed a modified method for the removal of gastric submucosal tumors (SMTs), called endoscopic mucosa-sparing lateral dissection (EMSLD). This prospective study aimed to evaluate the efficacy and postoperative outcomes of EMSLD. Methods We prospectively enrolled 25 consecutive patients with gastric SMTs, who received EMSLD treatment. Clinicopathological characteristics and operation-related outcomes were analyzed. Results The mean age of patients was 49.3 ± 9.7 years, and the mean tumor size was 14.6 ± 6.1 mm. En bloc resection was achieved in all cases. The mean procedure time was 47.3 ± 25.9 minutes, and the estimated blood loss was 4.8 ± 3.5 mL. Endoscopic full-thickness resection was performed in six patients (24 %) because the tumors originated from the deep muscularis propria layer. All perforations and resection defects were successfully closed by the retained mucosa and endoclips. No serious complications related to EMSLD were encountered during or after the procedure. Conclusions EMSLD was reliable and effective for the removal of gastric SMTs. However, large-scale randomized controlled trials are needed.

scholarly journals Endoscopic Resection of Esophageal Granular Cell Tumors: A Single Center Experience

2021 ◽  
Author(s):  
Kaipeng Liu ◽  
Yangyang Zhou ◽  
Qingfen Zheng ◽  
Dan Liu ◽  
Huiyu Yang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Muscularis Propria ◽  
Granular Cell ◽  
En Bloc Resection ◽  
Clinicopathological Characteristics ◽  
Maximum Diameter ◽  
R0 Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
The Mean

Abstract Background: Granular cell tumors (GCTs) are rare tumors probably originating from neurogenic Schwann cells. The aim was to evaluate the safety and feasibility of endoscopic resection for esophageal GCTs. Methods: The study retrospectively analyzed patients with pathologically diagnosed esophageal GCTs in our center from February 2012 to December 2020. Clinicopathological characteristics, endoscopic features and clinical outcomes were collected and analyzed. Results: 12 males and 10 females were identified. Lesions were located in the upper, middle and lower esophagus in three, six and thirteen cases respectively. 14 lesions (63.6%) exhibited white-to-yellow discoloration. The mean maximum diameter of these lesions was 5.7±2.2 mm (range 2-11.6 mm). The most lesions (91%) were located in the mucosa or submucosa layer, and 2 lesions (9.0%) were in the muscularis propria layer. Endoscopic mucosal resection (n=17), endoscopic submucosal dissection (n=4) and endoscopic submucosal excavation (n=1) were performed. En bloc resection was achieved in 20 lesions (90.9%). The R0 resection was achieved in 20 lesions (90.9%). No patients experienced intraoperative perforation or delayed bleeding in the mean length of postoperative hospital stay of 4.2±2.1 days (range 1-9 days). All patients had no recurrence or metastasis during the mean follow-up period of 48.1±27.2 months (range 2-102 months). Conclusion: Endoscopic resection is safe and effective for management of esophageal GCTs. Clinically, the appropriate approach of endoscopic resection should be selected according to the origin and size of the lesion.

scholarly journals Endoscopic Resection of Gastric Submucosal Masses by a Dental Floss Traction Method

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Chunyan Zeng ◽  
Yin Zhu ◽  
Xu Shu ◽  
Nonghua Lv ◽  
Qiang Cai ◽  
...  
Keyword(s):  
Dft Method ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Clinical Trial Registry ◽  
En Bloc ◽  
Dental Floss ◽  
Submucosal Tumors ◽  
Endoscopic Closure ◽  
Gastric Submucosal Tumors

Background and Aims. ESE (endoscopic submucosal excavation) is widely used for the treatment of digestive diseases. The dental floss traction (DFT) method has been successfully used to facilitate ESE to resect mucosal lesions such as early gastric cancer. DFT has not been used in ESE to remove submucosal masses. This study aimed to examine the efficacy of DFT-assisted ESE (DFT- ESE) for the removal of submucous masses.Methods. From March 2017 to May 2017, a total of 12 patients with gastric submucosal masses at the First Affiliated Hospital of Nanchang University, Jiangxi, China, were enrolled. The tumor characteristics, en bloc resection rates, complications, and outcomes on follow-up were evaluated for all patients.Results. The 12 submucosal tumors were completely removed by DFT- ESE. Nine were gastrointestinal stromal tumors. Two were Schwannoma, located in the greater curvature of the gastric corpus. One was gastric ectopic pancreas. All the resected tumors were removed completely with intact tumor capsules. There was no more bleeding or perforation after the endoscopic closure of the perforation or the wound after the DFT-ESE, and no recurrences were identified at the time of follow-up.Conclusions. The DFT method efficiently and safely facilitated the ESE procedure during the resection of gastric submucosal tumors. This study was registered with Chinese Clinical Trial Registry under Registration numberChiCTR-OOC-15005833).

scholarly journals Feasibility and Safety of Mark-Guided Submucosal Tunneling Endoscopic Resection for Treatment of Esophageal Submucosal Tumors Originating from the Muscularis Propria: A Single-Center Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ben-hua Wu ◽  
Rui-yue Shi ◽  
Hai-yang Zhang ◽  
Ting-ting Liu ◽  
Yan-hui Tian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Muscularis Propria ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Tumors ◽  
Procedure Duration

Background. Submucosal tunneling endoscopic resection (STER) has effectively removed esophageal submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. However, clinical failure and adverse events of STER remain concerned. In this study, we described a mark-guided STER (markings before creating entry point) and evaluated its feasibility and safety for esophageal SMTs originating from MP. Methods. Patients receiving the mark-guided STER from October 2017 to July 2020 were included and followed up (ranged from 3 to 30 months). The primary outcomes included complete resection, en bloc resection, and R0 resection rates. The secondary outcomes included procedure duration, main complication, and residual lesions. Results. A total of 242 patients with 242 SMTs (median diameter of 22 mm, ranging from 7 mm to 40 mm) received the mark-guided STER. The median procedure duration was 55 min (ranging from 35 min to 115 min). The complete resection, en bloc resection, and R0 resection rates were 100%, 98.3%, and 97.5%, respectively. The adverse event rate was 4.5%. However, there was no severe complication. No residual SMTs were detected during the follow-up period. Logistic regression demonstrated that the SMT size and procedure duration were independent factors associated with en bloc resection ( P = 0.02 and P = 0.04 , respectively). Moreover, logistic regression demonstrated that the SMT size was an independent risk factor for main complications ( P = 0.02 ). Conclusion. Mark-guided STER was feasible and safe to remove esophageal SMTs ≦40 mm. However, it is necessary to further verify the feasibility and safety for the esophageal SMTs >40 mm.

scholarly journals Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110298
Author(s):  
Jia Liu ◽  
Yuyong Tan ◽  
Deliang Liu ◽  
Chenjie Li ◽  
Meixian Le ◽  
...  
Keyword(s):  
Risk Factors ◽  
Submucosal Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Tumors ◽  
Gastric Submucosal Tumors ◽  
Inexperienced Surgeon ◽  
Endoscopic Submucosal Excavation

Objective Endoscopic submucosal excavation (ESE) has been established as an effective method for removal of gastric submucosal tumors (SMTs). The aim of the present study was to explore risk factors for technical difficulties in ESE. Methods In this retrospective study, we collected clinical data from patients who underwent ESE for gastric SMTs. Difficult ESE was defined as a procedure time ≥90 minutes, piecemeal resection, and/or occurrence of major adverse events. Univariate and multivariate analyses were performed to explore the risk factors for a difficult ESE. Results ESE was successfully performed in 96.5% (195/202) of patients from April 2011 to December 2019. The average tumor size was 17.41 mm, and en bloc resection was achieved in 97.4% of patients (190/195). Five patients (2.56%, 5/195) had complications, including two with delayed bleeding, two with fever, and one with chest pain accompanying ST-T changes in an electrocardiogram. Twenty-four patients (11.88%, 24/202) had a difficult ESE. Logistic analysis showed that outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE. Conclusion ESE may be safe and effective to treat patients with gastric SMTs. Outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE.

scholarly journals Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeongseok Kim ◽  
Jisup Kim ◽  
Eun Hye Oh ◽  
Nam Seok Ham ◽  
Sung Wook Hwang ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Neuroendocrine Tumors ◽  
Similar Efficacy ◽  
En Bloc Resection ◽  
Lesion Size ◽  
Bloc Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Mucosal Resection ◽  
The Mean

AbstractSmall rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

scholarly journals Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database

2016 ◽  
Vol 24 (4) ◽  
pp. 644-651 ◽  
Author(s):  
Ziya L. Gokaslan ◽  
Patricia L. Zadnik ◽  
Daniel M. Sciubba ◽  
Niccole Germscheid ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Survival Data ◽  
Large Scale ◽  
Surgical Techniques ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Increased Risk ◽  
Significant Difference ◽  
Mobile Spine

OBJECT A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96–16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

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

2020 ◽  
Author(s):  
Qiang Zhang ◽  
Jian-Qun Cai ◽  
Zhen Wang
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Operative Time ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Gastric Submucosal Tumors

Abstract 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%, P = 0.027). 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.

scholarly journals Endoscopic Mucosal Resection of a Proximal Esophageal Pyogenic Granuloma

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Elias Estifan ◽  
Varun Patel ◽  
Matthew Grossman
Keyword(s):  
Endoscopic Mucosal Resection ◽  
English Literature ◽  
Muscularis Propria ◽  
Pyogenic Granuloma ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Capillary Hemangioma ◽  
Prognostic Information ◽  
En Bloc ◽  
Mucosal Resection

Pyogenic Granuloma (PG), also known as lobular capillary hemangioma, is usually seen as a polypoid red lesion found on the skin or the mucosal surface of the oral cavity. PG of the gastrointestinal tract is rare, in particular involving the esophagus, only 14 cases have been reported in the English literature. We present an 80-year-old male who underwent endoscopy for evaluation of dysphagia and was found to have a single, red, bilobed 10 mm polyp with adherent white exudate approximately 19 cm from the incisors. Endoscopic ultrasound was performed with a 20 mHz miniprobe which showed the lesion contained to the mucosal layer with no muscularis propria invasion. A decision was made to perform endoscopic mucosal resection (EMR). A mixture of saline and methylene blue was injected into the submucosal plane to raise the lesion with subsequent successful mucosal hot snare resection. The resection defect was then approximated and closed with a hemostatic clip to prevent bleeding. Pathology of the specimen revealed small capillary vessels growing in a lobular architecture with an edematous stroma and a florid inflammatory infiltrate representing a pyogenic granuloma. EMR allows for an en bloc resection of mucosal lesions with tumor-free margins, thereby providing both diagnostic and prognostic information. Comparing EMR with the novel technique of endoscopic submucosal dissection (ESD), the incidence of bleeding and perforation is much lower; making EMR the best and safest resection option for this rare hemangioma. In this case, we demonstrate that EMR is a safe technique in removing a pyogenic granuloma in the esophagus.

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