Jian Gong, Tan Linna, Wang Hanyu, Lv Liang, Wang Xuehong, Qi Xiaoyun, Le Meixian, Tan Yuyong, Liu Deliang
Gastroenterology, The Second Xiangya Hospital.
Gastroenterology, The Second Xiangya Hospital of Central South Unive, China.
Rev Esp Enferm Dig. 2021 Jan;113(1):35-40. doi: 10.17235/reed.2020.7040/2020.
endoscopic full-thickness resection (EFTR) is widely accepted for the treatment of gastric submucosal tumors (SMTs). However, technical difficulties sometimes occur. The aim of the present study was to assess the safety and efficacy of EFTR for gastric SMTs and to explore risk factors for technical difficulty.
the clinical data of patients who received EFTR for gastric SMTs was retrospectively collected from April 2011 to September 2019. Efficacy was defined as an en bloc resection. Difficult EFTR was defined as a procedure time ≥ 120 minutes and/or the occurrence of major adverse events, such as major bleeding, abdominal pain or peritonitis. Finally, risk factors for technical difficulty of EFTR such as gender, age, tumor location, size, symptomatic, regular, outgrowth, operator experience and pathology were analyzed in a univariate and multivariate analysis.
one hundred SMTs were removed by EFTR. The average surgery time was 75.73 ± 45.9 (range: 20-250) minutes and the average tumor size was 16.23 ± 7.73 (range: 6-40) mm. With regard to efficacy, en bloc resection was achieved in 98 cases (98 %). A total of ten patients (9.9 %) had complications, namely two intra-operative bleeding, one delayed bleeding and seven patients had abdominal pain (overt peritonitis). EFTR was ceased in one patient due to massive intra-operative bleeding and conversion to laparoscopic surgery was necessary. One patient required laparoscopic surgery due to delayed bleeding, and other complications were resolved with a conservative treatment. A total of 18 cases (17.8 %) encountered a difficult EFTR: tumor size ≥ 3 cm (p = 0.008) and location at the gastric corpus (p = 0.007) were risk factors for a difficult EFTR according to the logistic analysis.
EFTR is safe and effective for the treatment of gastric SMTs. Tumor size of ≥ 3 cm and location at the gastric corpus are risk factors for a difficult EFTR.
内镜全层切除术（EFTR）已被广泛用于治疗胃黏膜下肿瘤（SMT）。然而，有时会出现技术难题。本研究旨在评估EFTR治疗胃SMT的安全性和有效性，并探讨技术难题的危险因素。
回顾性收集2011年4月至2019年9月期间接受EFTR治疗胃SMT患者的临床资料。疗效定义为完整切除。困难EFTR定义为手术时间≥120分钟和/或发生严重不良事件，如严重出血、腹痛或腹膜炎。最后，对EFTR技术难题的危险因素，如性别、年龄、肿瘤位置、大小、症状、形态、外生性、术者经验和病理进行单因素和多因素分析。
通过EFTR切除了100个SMT。平均手术时间为75.73±45.9（范围：20 - 250）分钟，平均肿瘤大小为16.23±7.73（范围：6 - 40）mm。在疗效方面，98例（98%）实现了完整切除。共有10例患者（9.9%）出现并发症，即2例术中出血、1例延迟出血和7例患者出现腹痛（明显腹膜炎）。1例患者因术中大量出血停止EFTR，需要转为腹腔镜手术。1例患者因延迟出血需要腹腔镜手术，其他并发症通过保守治疗得到解决。共有18例（17.8%）遇到困难EFTR：根据逻辑分析，肿瘤大小≥3 cm（p = 0.008）和位于胃体部（p = 0.007）是困难EFTR的危险因素。
EFTR治疗胃SMT安全有效。肿瘤大小≥3 cm和位于胃体部是困难EFTR的危险因素。
