Endoscopic transmural route for dissection of gastric submucosal tumors with extraluminal growth: experience in two cases

• Published in: Gut Vol. 70; no. 11; pp. 2052 - 2054
• Main Authors: Liu, Xinyang, Chen, Tianyin, Cheng, Jing, Gao, Pingting, Li, Quanlin, Chen, Weifeng, Zhang, Yiqun, Zhou, Pinghong, Hu, Jianwei
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Society of Gastroenterology 01.11.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Abdomen; Adult; Aged; Antibiotics; Digestive system; Dissection; Endoscopic procedures; Endoscopy; Endoscopy news; Gastric Mucosa - surgery; Gastrointestinal Stromal Tumors - surgery; Gastroscopy - methods; Growth patterns; Humans; Laparoscopy; Male; Mucosa; Pathology; Stomach Neoplasms - surgery; Surgery; Tumors; Endoscopic procedures
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2021-324027

In more detail With the popularisation of endoscopy and the development of endoscopic ultrasonography (EUS), the detection rate of gastrointestinal (GI) SMT has increased significantly.1 Complete surgical resection is still recognised as the primary and the most important way to treat gastric SMT and to get clear pathological diagnosis.2 Minimally invasive endoscopic therapy received increasing recognition due to its advantages of less invasiveness, fewer complications, quicker recovery and lower costs compared with open surgery or laparoscopic surgery. Gastric SMTs derived from mucosal and submucosal layers could be resected by endoscopic mucosal resection and endoscopic submucosal dissection, while those originated from deep layers of the gastric wall can be resected using endoscopic full-thickness resection (EFTR), which intentionally perforates the gastric wall to achieve complete resection.3 With an increasing emphasis on protecting the intact of mucosa, endoscopic mucosa-sparing lateral dissection was developed to reduce the postoperative complications.4 Inspired by the submucosal tunnelling endoscopic resection (STER)5 technique, in which maintenance of mucosal integrity and the longitudinal submucosal tunnel lead to rapid healing and decreased risk of pleural infection, STER for extraluminal tumours was reported for resection of SMTs with a predominant extraluminal growth pattern or extra-GI tumours.6 However, for most SMTs with a predominately extraluminal growth pattern, the lesions are usually in a tangent position during endoscopic dissection in all the above techniques. [...]the maintaining of mucosa intact at the lesion site and the short tunnel at the mucosal incision site could reduce infection and other complications due to perforation resulting from full-thickness resection. [...]the tunnel makes closure of the wound much easier than the otherwise unsmooth full-thickness defect created by EFTR.