Jiaoyang Lu1, Taotao Jiao2, Yanmei Li3, Minhua Zheng4, Xuefeng Lu5. 1. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China. 2. Department of Statistics, Shandong Provincial Hospital, Jinan, Shandong, China. 3. Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China; Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 4. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: zheng_minhua@yeah.net. 5. Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China.
Abstract
BACKGROUND AND AIMS: Endoscopic full-thickness resection (EFTR) is difficult to perform in a retroflexed fashion in the gastric fundus and lesser curvature. Here we describe two simple methods to provide countertraction and thereby facilitate dissection. METHODS: In this retrospective cohort study, 62 patients diagnosed as having gastric submucosal tumors in the fundus or in the lesser curvature received EFTR with or without countertraction methods. For the clip-with-thread method, a clip tied with surgical suture was anchored on the distal edge of the tumor to provide countertraction; for the loop-assisted method, a snare placed on the transparent cap beforehand was adopted to grasp the tumor to provide countertraction. RESULTS: Mean operative time was significantly reduced in the thread-with-clip group and loop-assisted group (45 minutes, 40 minutes, respectively) compared with the time needed in the traditional EFTR group (85 minutes). Intraoperative pneumoperitoneum occurred regularly among the 3 groups because of iatrogenic perforation, but fewer patients in the thread-with-clip group and loop-assisted group (23%, 18%, respectively) needed abdominal puncture to relieve free air and stabilize life signs compared with patients in the traditional EFTR group (63%). A reduced occurrence of high fever after surgery may contribute as another advantage from accelerated dissection. Both techniques did not jeopardize oncologic safety during short-term follow-up. CONCLUSIONS: Both the thread-with-clip method and loop-assisted method provide effective countertraction and offer faster and safer gastric EFTR in difficult anatomic locations.
BACKGROUND AND AIMS: Endoscopic full-thickness resection (EFTR) is difficult to perform in a retroflexed fashion in the gastric fundus and lesser curvature. Here we describe two simple methods to provide countertraction and thereby facilitate dissection. METHODS: In this retrospective cohort study, 62 patients diagnosed as having gastric submucosal tumors in the fundus or in the lesser curvature received EFTR with or without countertraction methods. For the clip-with-thread method, a clip tied with surgical suture was anchored on the distal edge of the tumor to provide countertraction; for the loop-assisted method, a snare placed on the transparent cap beforehand was adopted to grasp the tumor to provide countertraction. RESULTS: Mean operative time was significantly reduced in the thread-with-clip group and loop-assisted group (45 minutes, 40 minutes, respectively) compared with the time needed in the traditional EFTR group (85 minutes). Intraoperative pneumoperitoneum occurred regularly among the 3 groups because of iatrogenic perforation, but fewer patients in the thread-with-clip group and loop-assisted group (23%, 18%, respectively) needed abdominal puncture to relieve free air and stabilize life signs compared with patients in the traditional EFTR group (63%). A reduced occurrence of high fever after surgery may contribute as another advantage from accelerated dissection. Both techniques did not jeopardize oncologic safety during short-term follow-up. CONCLUSIONS: Both the thread-with-clip method and loop-assisted method provide effective countertraction and offer faster and safer gastric EFTR in difficult anatomic locations.
Authors: Harry R Aslanian; Amrita Sethi; Manoop S Bhutani; Adam J Goodman; Kumar Krishnan; David R Lichtenstein; Joshua Melson; Udayakumar Navaneethan; Rahul Pannala; Mansour A Parsi; Allison R Schulman; Shelby A Sullivan; Nirav Thosani; Guru Trikudanathan; Arvind J Trindade; Rabindra R Watson; John T Maple Journal: VideoGIE Date: 2019-06-29
Authors: Vincent Huberty; Loulia Leclercq; Martin Hiernaux; Laurine Verset; Charlotte Sandersen; Thorsten Beyna; Horst Neuhaus; Jacques Deviere Journal: Endosc Int Open Date: 2019-10-22