Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
Endoscopy Research Institute of Fudan University, Shanghai, 200032, China.
Surg Endosc. 2019 Nov;33(11):3864-3873. doi: 10.1007/s00464-019-06920-w. Epub 2019 Aug 2.
Endoscopic full-thickness resection (EFTR) provides a significant advancement to the treatment of gastrointestinal submucosal tumors (SMTs). However, technological challenges, particularly in the gastric fundus, hinder its wider application. Here, we investigated the efficacy of a simple traction method that used dental floss and a hemoclip (DFC) to facilitate EFTR.
Between July 2014 and December 2016, we retrospectively reviewed data from all patients with SMTs in the gastric fundus originating from the muscularis propria layer that were treated by EFTR at Zhongshan Hospital of Fudan University. Baseline characteristics and clinical outcomes, including procedure time and complications rate, were compared between groups of patients receiving DFC-EFTR and conventional EFTR.
A total of 192 patients were included in our analysis (64 in the DFC-EFTR group and 128 in the conventional EFTR group). Baseline characteristics for the two groups were similar. The mean time for DFC-EFTR and conventional EFTR was 44.2 ± 24.4 and 54.2 ± 33.2 min, respectively (P = 0.034). Although no serious adverse events presented in any of our cases, post-EFTR electrocoagulation syndrome (PEECS), as a minor complication, was less frequent in the DFC-EFTR group (3.1% vs. 12.5%, P = 0.036). Univariate and multivariate analysis identified that DFC, when used in EFTR, played a significant role in reducing procedure time and the rate of PEECS. The mean procedure time was significantly shorter in the DFC-EFTR group for lesions over 1.0 cm (P = 0.005), when the lesions were located in the greater curvature of the gastric fundus (P = 0.025) or when the lesions presented with intraluminal growth (P = 0.032). Moreover, when EFTR was carried out by experts, the mean procedure time was 20.4% shorter in the DFC-EFTR group (P = 0.038).
This study indicated that DFC-EFTR for SMTs in the gastric fundus resulted in a shorter procedure time and reduced the risk of PEECS, a minor complication.
内镜全层切除术（EFTR）为胃肠道黏膜下肿瘤（SMT）的治疗提供了重大进展。然而，技术挑战，尤其是在胃底部位，阻碍了其更广泛的应用。在这里，我们研究了一种简单的牵引方法的效果，该方法使用牙线和止血夹（DFC）来促进 EFTR。
2014 年 7 月至 2016 年 12 月，我们回顾性分析了复旦大学中山医院收治的来源于固有肌层的胃底 SMT 患者的内镜全层切除术数据。比较了接受 DFC-EFTR 和常规 EFTR 治疗的患者的手术时间和并发症发生率等临床结果。
共纳入 192 例患者（DFC-EFTR 组 64 例，常规 EFTR 组 128 例）。两组患者的基线特征相似。DFC-EFTR 和常规 EFTR 的平均手术时间分别为 44.2±24.4 分钟和 54.2±33.2 分钟（P=0.034）。虽然我们的病例中没有出现严重的不良事件，但 EFTR 后电凝综合征（PEECS）作为一种轻微并发症，在 DFC-EFTR 组中较少见（3.1% vs. 12.5%，P=0.036）。单因素和多因素分析表明，DFC 在 EFTR 中可显著缩短手术时间和 PEECS 发生率。在病灶直径>1.0cm（P=0.005）、胃底大弯侧（P=0.025）或腔内生长（P=0.032）的情况下，DFC-EFTR 组的平均手术时间显著缩短。此外，当由专家进行 EFTR 时，DFC-EFTR 组的平均手术时间缩短了 20.4%（P=0.038）。
本研究表明，DFC-EFTR 治疗胃底 SMT 可缩短手术时间，降低 PEECS 这一轻微并发症的风险。
