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 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 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 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 Applying basic principles of surgery may pave the way for more effective endoscopic bariatric techniques

2021 ◽  
Vol 09 (07) ◽  
pp. E1049-E1054
Author(s):  
Kiyoshi Hashiba ◽  
Carlos Alberto Cappellanes ◽  
Pablo Rodrigo de Siqueira ◽  
Antonio Carlos Conrado ◽  
Bruno Ribeiro ◽  
...  
Keyword(s):  
Gastric Wall ◽  
Muscularis Propria ◽  
Suture Technique ◽  
Great Success ◽  
Basic Principles ◽  
Endoscopic Techniques ◽  
Novel Device ◽  
Surgical Suture ◽  
Deep Layers ◽  
The Way

Abstract Background and study aims In the last decade, gastroenterologists have been attempting to use endoscopy to reproduce the great success of traditional surgical suture techniques. Despite recent advances, we still lack a reliable method that results in a permanent suture with minimal incidence of suture failure. This was an experimental study in pigs with an innovative technique that applied basic surgical concepts to endoscopy to evaluate the effectiveness of a novel suture technique. Methods The procedures were performed on six live pigs under general anesthesia. Endoscopic mucosal resection (EMR) first was performed in the stomach, exposing the submucosal or muscularis propria layers. A novel device, a transparent chamber cap (DASE), was developed to aspirate the gastric wall, allowing the sutures to reach deep layers. The aspiration was performed with a standard gastroscope to which the novel cap was distally attached. Three sutures aligned were defined as a plication. Each pig received two or three plications and was placed on a liquid diet for 14 days after the procedure. The pigs were sacrificed at 4 and 8 weeks and the sutures were reviewed. Results The technique was feasible in all animals. Of 16 plications, only one failed. One perforation occurred after EMR. There were no other complications or adverse events. Permanent fusion of the gastric wall was confirmed by histology in all cases. Conclusions This study showed that basic principles of surgery can be applied endoscopically to ensure a permanent suture with reduced chances of failure. These findings can help to pave the way for more effective bariatric endoscopic techniques.

scholarly journals Open submucosal tunneling endoscopic resection for special submucosal tumors originating from the muscularis propria

2020 ◽  
Author(s):  
Silin Huang ◽  
Sufang Tu ◽  
Jingwen Fu ◽  
Xiaowei Tang ◽  
Genhua Yang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Muscularis Propria ◽  
Operation Time ◽  
Primary Treatment ◽  
En Bloc ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Tumors ◽  
Endoscopic Techniques ◽  
The Mean

Abstract Background and Purpose Esophageal submucosal tumors (SMTs) are primarily benign but can have the potential for malignancy. Surgery is the primary treatment; however, the development of endoscopic techniques has promoted the use of endoscopic resection for esophageal SMTs. Submucosal tunneling endoscopic resection (STER) is the current optimal treatment for esophageal SMTs; however, it is challenging to perform in cases of tumors located in the upper esophagus and cardia as well as those with a diameter > 3.5 cm. Based on STER, we proposed and used open STER (O-STER) for special esophageal SMTs. The study aimed to evaluate the safety and efficacy of O-STER for special esophageal SMTs, including those located in the upper esophagus and cardia and those with a diameter > 3.5 cm. Methods The study enrolled 21 patients whose baseline characteristics, clinical data, and follow-up results were retrospectively analyzed. Results A total of 21 lesions were resected. The mean patient age was 44.2 ± 14.4 years. The mean tumor size was 38.2 ± 12.2 mm; 16 (76.2%) tumors had a diameter ≥ 3.5 cm. Tumors were in the cardia in 14 (66.7%) cases and in the upper esophagus in 2 (9.5%) cases. The mean operation time was 56.7 ± 19.3 minutes. The en bloc and complete resection rates were both 100%. There was 1 (4.8%) case of subcutaneous emphysema; no other serious complications were noted. Pathological examinations suggested that most tumors were leiomyomas and had negative margins. During the mean follow-up period of 26.7 months, no cases of residue, recurrence, or metastasis were observed. Conclusions O-STER is a safe and effective treatment for special esophageal SMTs that can reduce operative difficulty and complication rate.

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.

scholarly journals Rare lung cancers—Primary pulmonary leiomyosarcoma: A case report

2021 ◽  
Author(s):  
Laurenz Nagl ◽  
Andreas Seeber ◽  
Gerlig Widmann ◽  
Katja Schmitz ◽  
Herbert Maier ◽  
...  
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Tumour Size ◽  
Lymph Node Status ◽  
R0 Resection ◽  
Interdisciplinary Management ◽  
Curative Surgery ◽  
Lung Cancers ◽  
Tumour Control ◽  
Complete Tumour

SummaryPrimary pulmonary sarcomas (PPS) are rare mesenchymal lung cancers, which do not present clinically or radiological different to lung carcinomas. Definite PPS diagnosis can only be made by histological analysis and detailed staging examinations in order to exclude a secondary pulmonary malignancy such as metastatic soft tissue sarcoma or another solid tumour. Here we present the case of a 66-year-old woman with a pulmonary mass infiltrating the diaphragm and the mediastinal adipose tissue, which was identified as leiomyosarcoma. The patient received curative surgery with complete tumour R0 resection. The prognosis of PPS is defined by tumour size, lymph node status and histological grading. Surgery is the mainstay of therapy and there is no definitive indication for adjuvant therapy for R0-resected and lymph-node-negative patients like in our case. However, multimodal therapy approaches such as (neo)adjuvant chemo- and radiotherapy can contribute to improving locoregional tumour control, which is the most important prognostic factor. With our case report we want to raise awareness for pulmonary sarcomas as a relevant proportion of rare lung cancers which have to be kept in mind during the differential diagnosis. Moreover, we aim to discuss the complex and individual interdisciplinary management.

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.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
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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