Technische Universität München, Munich, Germany.
Endoscopy. 2013;45(1):4-11. doi: 10.1055/s-0032-1325760. Epub 2012 Dec 19.
Endoscopic resection of gastric subepithelial tumors (SETs) carries a high risk of perforation. New techniques such as use of the over-the-scope clip (OTSC) may enable secure endoscopic closure of perforations. We aimed to evaluate the feasibility of endoscopic resection of small gastric SETs using a grasp-and-snare technique followed by OTSC closure of the gastric wall if necessary.
In this prospective study 20 consecutive patients who presented with gastric SETs ≤ 3 cm were enrolled. Endoscopic resection was performed using a double-channel endoscope, a tissue anchor and a monofilament snare. If perforation occurred, the aim was to achieve complete closure with a tissue twin grasper and the OTSC. Procedures were performed under laparoscopic control using a 5-mm optic, which was introduced via a single 5-mm trocar through the umbilicus. All patients were followed up for 3 months after the procedure.
In 6 /20 patients a pure endoscopic approach was impossible and a switch to laparoscopic wedge resection was necessary (large tumor size in 2 /6 patients; mainly extraluminal growth in 4 /6 patients). Solely endoscopic resection was successfully performed in the remaining 14 patients. Amongst these, laparoscopic control was impossible in two cases. Perforation occurred in 6 /14 patients but gastric closure with the OTSC was performed successfully in all these cases. No complications occurred and follow-up was unremarkable.
Endoscopic snare resection enables safe treatment of small gastric SETs (diameter ≤ 3 cm) and seems faster and easier to perform than other endoscopic resection techniques, such as endoscopic submucosal dissection (ESD) or submucosal tunneling. Perforations occurring after full-thickness resection can be adequately managed by OTSC closure. Solely endoscopic resection without laparoscopic control seems possible in selected patients with tumors known to have purely intraluminal growth.
内镜下胃黏膜下肿瘤（SET）切除术穿孔风险较高。使用过内镜下全层切除术（OTSC）等新技术可能能够安全地闭合穿孔。我们旨在评估使用抓握和套扎技术进行小的胃 SET 内镜下切除术的可行性，如果必要，随后使用 OTSC 闭合胃壁。
在这项前瞻性研究中，纳入了 20 例连续就诊的胃 SETs ≤ 3cm 的患者。使用双通道内镜、组织锚和单丝套扎器进行内镜下切除术。如果发生穿孔，则采用组织双爪夹和 OTSC 实现完全闭合。所有操作均在腹腔镜控制下进行，通过脐部单个 5mm 套管针引入 5mm 光学镜。所有患者在手术后均进行 3 个月的随访。
在 6/20 例患者中，单纯内镜方法无法进行，需要转换为腹腔镜楔形切除术（2/6 例患者肿瘤较大；主要为 6/6 例患者为腔外生长）。其余 14 例患者仅通过内镜成功进行了切除术。在这 14 例患者中，有 2 例无法进行腹腔镜控制。在 6/14 例患者中发生穿孔，但所有这些患者均成功地通过 OTSC 闭合了胃壁。无并发症发生，随访无异常。
内镜套扎切除术能够安全地治疗小的胃 SETs（直径 ≤ 3cm），且似乎比其他内镜切除术技术（如内镜黏膜下剥离术或黏膜下隧道切除术）更快、更容易操作。全层切除后发生的穿孔可以通过 OTSC 闭合充分处理。在已知具有单纯腔内生长的肿瘤的选择患者中，似乎可以仅通过内镜切除而无需腹腔镜控制。
