Bing Li1,2, Tao Chen1,2, Zhi-Peng Qi1,2, Li-Qing Yao1,2, Mei-Dong Xu1,2, Qiang Shi1,2, Shi-Lun Cai1,2, Di Sun1,2, Ping-Hong Zhou3,4, Yun-Shi Zhong5,6. 1. Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China. 2. Endoscopy Research Institute of Fudan University, Shanghai, 200032, China. 3. Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China. zhoupinghongzs@yahoo.com. 4. Endoscopy Research Institute of Fudan University, Shanghai, 200032, China. zhoupinghongzs@yahoo.com. 5. Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China. zhongyunshi@yahoo.com. 6. Endoscopy Research Institute of Fudan University, Shanghai, 200032, China. zhongyunshi@yahoo.com.
Abstract
BACKGROUND: Gastric small submucosal tumors (SMTs) are becoming increasingly common. However, the fundus of stomach is regarded as a difficult area for endoscopic resection (ER). In this study, we investigated the efficacy, safety, and long-term outcomes of ER for small SMTs of the gastric fundus in a large series of patients, research that was previously lacking. METHODS: 537 consecutive patients with SMTs no more than 20 mm in diameter, occurring in the gastric fundus and originating from the muscularis propria layer, which were treated with endoscopic submucosal excavation or endoscopic full-thickness resection (EFTR) were included in this retrospective study at Zhongshan Hospital of Fudan University from January 2013 to September 2016. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. RESULTS: En bloc resection was achieved in 100% of patients, and complete resection was achieved for 530 (98.7%) lesions. Although the total rate of complications was 9.3%, few serious adverse events occurred in only three (0.6%) patients, including major pneumoperitoneum, major hydrothorax, and bleeding. Unlike lager tumor sizes and longer procedure times, endoscopist experience had a positive impact on decreasing the likelihood of complications. Based on statistical analysis, tumors with greater size near the cardia, which were treated by EFTR, were the significant contributors to longer operative times. A median follow-up of 32 months was available, and all patients were free from local recurrence or distant metastasis during the study period. CONCLUSIONS: Although the gastric fundus presents technical difficulties, ER is effective for the resection of small gastric SMTs with a high complete resection rate and rare serious adverse events.
BACKGROUND:Gastric small submucosal tumors (SMTs) are becoming increasingly common. However, the fundus of stomach is regarded as a difficult area for endoscopic resection (ER). In this study, we investigated the efficacy, safety, and long-term outcomes of ER for small SMTs of the gastric fundus in a large series of patients, research that was previously lacking. METHODS: 537 consecutive patients with SMTs no more than 20 mm in diameter, occurring in the gastric fundus and originating from the muscularis propria layer, which were treated with endoscopic submucosal excavation or endoscopic full-thickness resection (EFTR) were included in this retrospective study at Zhongshan Hospital of Fudan University from January 2013 to September 2016. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. RESULTS: En bloc resection was achieved in 100% of patients, and complete resection was achieved for 530 (98.7%) lesions. Although the total rate of complications was 9.3%, few serious adverse events occurred in only three (0.6%) patients, including major pneumoperitoneum, major hydrothorax, and bleeding. Unlike lager tumor sizes and longer procedure times, endoscopist experience had a positive impact on decreasing the likelihood of complications. Based on statistical analysis, tumors with greater size near the cardia, which were treated by EFTR, were the significant contributors to longer operative times. A median follow-up of 32 months was available, and all patients were free from local recurrence or distant metastasis during the study period. CONCLUSIONS: Although the gastric fundus presents technical difficulties, ER is effective for the resection of small gastric SMTs with a high complete resection rate and rare serious adverse events.
Authors: Margaret von Mehren; R Lor Randall; Robert S Benjamin; Sarah Boles; Marilyn M Bui; Ernest U Conrad; Kristen N Ganjoo; Suzanne George; Ricardo J Gonzalez; Martin J Heslin; John M Kane; Henry Koon; Joel Mayerson; Martin McCarter; Sean V McGarry; Christian Meyer; Richard J O'Donnell; Alberto S Pappo; I Benjamin Paz; Ivy A Petersen; John D Pfeifer; Richard F Riedel; Scott Schuetze; Karen D Schupak; Herbert S Schwartz; William D Tap; Jeffrey D Wayne; Mary Anne Bergman; Jillian Scavone Journal: J Natl Compr Canc Netw Date: 2016-06 Impact factor: 11.908
Authors: Alexander J Eckardt; Andreas Adler; Eleonora M Gomes; Christian Jenssen; Christine Siebert; Uwe Gottschalk; Martin Koch; Christoph Röcken; Thomas Rösch Journal: Eur J Gastroenterol Hepatol Date: 2012-10 Impact factor: 2.566