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

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.

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Su1847 Hybrid Push-Pull Endoscopic and Laparoscopic Full-Thickness Resection for the Minimally Invasive Management of Gastric Gastrointestinal Stromal Tumors (GIST)

Gastroenterology ◽

10.1016/s0016-5085(14)63834-8 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-1051-S-1052

Author(s):

Paul T. Reynolds ◽

Field F. Willingham ◽

Shishir K. Maithel ◽

Melinda M. Lewis ◽

Andrew S. Ross ◽

...

Keyword(s):

Minimally Invasive ◽

Gastrointestinal Stromal Tumors ◽

Full Thickness ◽

Stromal Tumors ◽

Invasive Management

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528 Hybrid Push-Pull Endoscopic and Laparoscopic Full-Thickness Resection for the Minimally Invasive Management of Gastric Gastrointestinal Stromal Tumors (GIST)

Gastroenterology ◽

10.1016/s0016-5085(14)63717-3 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-1021

Author(s):

Paul T. Reynolds ◽

Melinda M. Lewis ◽

Andrew S. Ross ◽

Shishir K. Maithel ◽

Flavio G. Rocha ◽

...

Keyword(s):

Minimally Invasive ◽

Gastrointestinal Stromal Tumors ◽

Full Thickness ◽

Stromal Tumors ◽

Invasive Management

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Minimally Invasive Resection of Large Gastric Gastrointestinal Stromal Tumors

Digestive Surgery ◽

10.1159/000510386 ◽

2020 ◽

Vol 37 (6) ◽

pp. 441-446

Author(s):

Emma C. Gertsen ◽

Gijs I. van Boxel ◽

Lodewijk A.A. Brosens ◽

Jelle P. Ruurda ◽

Richard van Hillegersberg

Keyword(s):

Minimally Invasive ◽

Gastrointestinal Stromal Tumors ◽

Tumor Regression ◽

Medical Center ◽

Disease Free Survival ◽

Partial Gastrectomy ◽

R0 Resection ◽

Gastric Gist ◽

Intraoperative Complication ◽

Stromal Tumors

Introduction: Gastrointestinal stromal tumors (GISTs) frequently present as a large exophytically growing mass in the stomach, for which open partial gastrectomy is standard of care. The aim of this study was to evaluate the safety and feasibility of minimally invasive gastric resection (MIG) of large (>5 cm) GIST. Methods: All patients who underwent MIG for a GIST in the University Medical Center Utrecht between 2011 and 2019 were included. Postoperative course and oncological outcomes were analyzed. Results: Twenty-two patients with gastric GIST, median size 53 mm [20–175 mm], underwent MIG. In 4 patients, preoperative imatinib was given, aiming for tumor regression. Conversion from laparoscopic to open surgery occurred once (5%). An additional resection was performed in 3 patients (14%). In 2 patients (9%), an intraoperative complication occurred, consisting of tumor rupture in 1 patient (5%), and 6 patients (27%) developed postoperative complications. Median hospital stay was 5 days [3–7 days]. R0 resection was achieved in 96%. In 4 patients, adjuvant treatment was indicated. The median follow-up was 31 months, and 1-, 3- and 5-year disease-free survival were 94, 74 and 74%, respectively. One patient presented with local recurrence 2 years after the index resection. Conclusion: MIG for large GIST up to 17.5 cm in diameter is safe, feasible, and oncologically sound, allowing for a controlled resection and reduced patient morbidity.

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

Journal of Clinical Medicine ◽

10.3390/jcm9061776 ◽

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.

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

Endoscopy International Open ◽

10.1055/a-1127-3092 ◽

2020 ◽

Vol 08 (05) ◽

pp. E611-E616 ◽

Cited By ~ 1

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.

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Clinical feasibility and safety of third space robotic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumors dissection

Surgical Endoscopy ◽

10.1007/s00464-019-07223-w ◽

2019 ◽

Vol 33 (12) ◽

pp. 4192-4200

Author(s):

Feiyu Shi ◽

Yingchao Li ◽

Yanglin Pan ◽

Qi Sun ◽

Guanghui Wang ◽

...

Keyword(s):

Adverse Events ◽

Gastrointestinal Stromal Tumors ◽

Third Space ◽

Operation Time ◽

R0 Resection ◽

Gastric Gist ◽

Minimal Invasiveness ◽

Stromal Tumors ◽

Gastric Gists ◽

Mucosal Layer

Abstract Background Surgical management of gastric gastrointestinal stromal tumors (GISTs) has evolved towards minimal invasiveness. Laparoscopic wedge resection and laparoscopic and endoscopic cooperative surgery had been considered as standard surgical treatments for gastric GISTs > 2 cm. However, stomach deformation and the full-thickness gastric defect caused by these procedures may increase the risk of morbidity. To address these problems, we developed a novel technique, third space robotic and endoscopic cooperative surgery (TS-RECS), which could dissect the tumor entirely while preserving the intact mucosal layer. Here we performed a prospective evaluation of the feasibility and safety of TS-RECS. Methods Patients with gastric GISTs were recruited between April 2018 and April 2019. During the operation, the gastric GIST was located by endoscopic view firstly and the submucosal injection was performed. The tumor was then dissected through robotic surgery. Clinicopathological characteristics, operative data, adverse events, and follow-ups were prospectively collected and analyzed. Results A total of 20 patients with gastric GISTs received TS-RECS. The mean tumor size was 33.0 ± 7.3 mm. R0 resection was achieved in all patients with a median operation time of 115 min and a median blood loss of 20 ml. The integrity of mucosal layer was maintained in 95% (19/20) of the patients. All patients started oral diet on postoperative day 1 or 2, staying in the hospital for a median of 6 days after surgery. There were no major adverse events. Local or distant recurrences were not observed during a median follow-up period of 10 months. Conclusions Our study suggests that TS-RECS appears to be a feasible and safe technique which could be an alternative method for resecting gastric GISTs > 2 cm. Clinical Trials ClinicalTrials.gov NCT03804762.

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Endoscopic resection of gastric gastrointestinal stromal tumors

Translational Gastroenterology and Hepatology ◽

10.21037/tgh.2017.12.03 ◽

2017 ◽

Vol 2 (12) ◽

pp. 115-115 ◽

Cited By ~ 20

Author(s):

Yuyong Tan ◽

Linna Tan ◽

Jiaxi Lu ◽

Jirong Huo ◽

Deliang Liu

Keyword(s):

Endoscopic Resection ◽

Gastrointestinal Stromal Tumors ◽

Stromal Tumors

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Clinical Overview of GIST and Its Latest Management by Endoscopic Resection in Upper GI: A Literature Review

Gastroenterology Research and Practice ◽

10.1155/2018/6864256 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Cicilia Marcella ◽

Rui Hua Shi ◽

Shakeel Sarwar

Keyword(s):

Endoscopic Resection ◽

Gastrointestinal Stromal Tumors ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Endoscopic Techniques ◽

Stromal Tumors ◽

Upper Gi ◽

Risk Of Malignancy

Aims. To review the clinical presentation, diagnosis, assessment of risk of malignancy, and recent advances in management (mainly focusing on the role of endoscopic resection) of gastrointestinal stromal tumors (GISTs) in upper GI.Method. We searched Embase, Web of science, and PubMed databases from 1993 to 2018 by using the following keywords: “gastrointestinal stromal tumors,” “GIST,” “treatment,” and “diagnosis.” Additional papers were searched manually from references of the related articles.Findings. The improvement of endoscopic techniques in treating upper gastrointestinal subepithelial tumors especially gastrointestinal tumors has reduced the need for invasive surgery in patients unfit for surgery. Many studies have concluded that modified endoscopic treatments are effective and safe. These treatments permit minimal tissue resection, better dissection control, and high rates of en bloc resection with an acceptable rate of complications.

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