Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumuqi, 830011, People's Republic of China.
Surg Endosc. 2017 Oct;31(10):4275-4282. doi: 10.1007/s00464-017-5473-5. Epub 2017 Apr 3.
Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal (GI) lesions originating from the muscularis propria layer. Successful closure of the wall defect is a critical step.
The aim of this study was to evaluate the feasibility and efficacy of a novel and simplified endoscopic grasp-and-loop (GAL) closure method using an endo-loop assisted with grasping forceps for defect closure.
From January 2015 to March 2016, 13 patients with submucosal tumors (SMTs) originating from the muscularis propria (MP) layer underwent EFTR and were enrolled in this study. After successful tumor resection, an endo-loop was anchored onto the circumferential margin of the gastric defect with grasping forceps assistance and tightened gently. Patient characteristics, tumor size, en bloc resection, and postoperative complications were evaluated.
Of the 13 lesions in the stomach, two were located in the greater curvature of the mid-upper body, 11 were located in the fundus. The endoscopic GAL closure method was successfully performed after EFTR in all the 13 patients without laparoscopic assistance. The mean procedure time was 43.5 min (range 20-80 min), while the GAL closure procedure took a mean of 9.4 min (range 3-18 min). The mean resected lesion size was 1.5 cm (range 0.5-3.5 cm). Pathological diagnoses of these lesions were 11 gastrointestinal stromal tumors (GISTs) and two leiomyomas. No major adverse events occurred during or after the procedure. All the patients were discharged after a mean time of 2.4 days (range 1-4 days). No residual lesion or tumor recurrence was found during the follow-up period (median, 5 months; range, 1-15 months).
The endoscopic GAL closure method is feasible, effective, and safe for closing the gastric defect after EFTR in patients.
内镜全层切除术（EFTR）是一种用于整块切除起源于固有肌层的胃肠道（GI）病变的微创方法。成功闭合壁缺损是一个关键步骤。
本研究旨在评估一种新型简化内镜抓握环（GAL）闭合方法的可行性和疗效，该方法使用带有抓握钳的内镜环辅助闭合缺损。
2015 年 1 月至 2016 年 3 月，13 例起源于固有肌层（MP）层的黏膜下肿瘤（SMT）患者接受 EFTR 治疗，并纳入本研究。成功切除肿瘤后，用抓握钳辅助将内镜环锚定于胃缺损的环形边缘，并轻轻收紧。评估患者特征、肿瘤大小、整块切除和术后并发症。
在 13 个胃部病变中，2 个位于中上体的大弯侧，11 个位于胃底部。在没有腹腔镜辅助的情况下，所有 13 例患者均成功实施 EFTR 后行内镜 GAL 闭合。平均手术时间为 43.5 分钟（范围 20-80 分钟），而 GAL 闭合程序平均用时 9.4 分钟（范围 3-18 分钟）。平均切除病变大小为 1.5 厘米（范围 0.5-3.5 厘米）。这些病变的病理诊断为 11 例胃肠道间质瘤（GIST）和 2 例平滑肌瘤。术中及术后无重大不良事件发生。所有患者平均住院 2.4 天（范围 1-4 天）后出院。在随访期间（中位时间 5 个月；范围 1-15 个月）未发现残留病变或肿瘤复发。
内镜 GAL 闭合方法对于 EFTR 后胃缺损的闭合是可行、有效且安全的。
