The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Turk J Gastroenterol. 2020 Dec;31(12):942-947. doi: 10.5152/tjg.2020.19685.
BACKGROUND/AIMS: Successful closure of gastric wall defects is a pivotal step for endoscopic full-thickness resection (EFTR). Our study indicates that for submucosal tumors (SMTs) smaller than 2.5 cm, closing the mucosal layer is safe and feasible when the modified method, ZIP, is used.
We retrospectively analyzed 37 patients with gastric SMTs arising from the muscularis propria (MP) who underwent EFTR with defect closure of the mucosal layer. The main procedure involved: (1) making a longitudinal incision of the mucosal and submucosal layers above the lesion, (2) fully exposing the lesion and symmetrically punching holes on both sides of the incision into the submucosal layer, (3) en bloc resection of the lesion using an electrosurgical snare or knife, (4) hooking of metallic clips into the holes and clipping of the mucosal layer successively to close the gastric wall defect. This modified method was named ZIP.
Successful complete resection by EFTR was achieved in 37 cases (100%). The median procedure time was 60 min (range: 30-120 min), whereas the closure procedure took a median of 8 min (range: 5-20 min). The median lesion size was 1.0 cm (range: 0.5-2.5 cm). No patients had severe complications. No residual lesions or tumor recurrence were found during the follow-up period.
Closing the mucosal layer of gastric wall defects after EFTR by ZIP is feasible and effective.
背景/目的：成功关闭胃壁缺损是内镜全层切除术（EFTR）的关键步骤。我们的研究表明，对于小于 2.5cm 的黏膜下肿瘤（SMT），当使用改良的 ZIP 方法时，闭合黏膜层是安全可行的。
我们回顾性分析了 37 例起源于固有肌层（MP）的胃 SMT 患者，这些患者接受了 EFTR 并对黏膜层进行了缺损闭合。主要步骤包括：（1）在病变上方的黏膜和黏膜下层做一个纵向切口；（2）充分暴露病变，并在切口两侧的黏膜下层对称打孔；（3）使用电外科圈套器或手术刀整块切除病变；（4）将金属夹钩入孔中，依次夹闭黏膜层以闭合胃壁缺损。这种改良方法被命名为 ZIP。
37 例（100%）患者成功完成 EFTR 完全切除。中位手术时间为 60 分钟（范围：30-120 分钟），而闭合程序的中位时间为 8 分钟（范围：5-20 分钟）。中位病变大小为 1.0cm（范围：0.5-2.5cm）。无患者发生严重并发症。在随访期间，未发现残留病变或肿瘤复发。
通过 ZIP 闭合 EFTR 后胃壁缺损的黏膜层是可行且有效的。
