Sun Haibo, Cao Tingting, Zhang Fan, Tao Ke, Xu Hong
Department of Gastroenterology and Endoscopy Center, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021, China.
Surg Endosc. 2023 Jan;37(1):234-240. doi: 10.1007/s00464-022-09457-7. Epub 2022 Aug 3.
Complete closure of gastric wall defects is critical following endoscopic full-thickness resection (EFTR). The aim of this study was to evaluate the efficacy, safety, and clinical outcome of a new endoscopic method: closing while dissecting.
Twenty-seven patients who underwent EFTR were retrospectively analyzed between January 2020 and March 2021. Gastric defects resulting from EFTR were closed using the "interrupted-close during dissection" technique with endoclips. Tumor characteristics, en bloc resection rates, and postoperative adverse events were evaluated.
All submucosal tumors were successfully resected and complete resection was histologically confirmed. The mean maximal tumor diameter was 1.3 cm (ranging from 0.8 to 3.0 cm). The majority of these tumors were gastrointestinal stromal tumors (n = 20), Leiomyoma (n = 3), schwannomas (n = 2), others included fibroma (n = 1) and neurogenic tumor (n = 1). There were no cases of hemorrhage, peritonitis, or delayed perforation. Four patients complained of slight abdominal pain, but no hyperpyrexia or serious elevated white blood cell count was detected in the first 24 h after treatment. All wounds were healed on follow-up endoscopy 3 months after the procedure. The mean follow-up duration was 8.5 months (ranging from 3 to 17) and no tumor recurrences were observed.
The feasibility and safety of this interrupted-close during dissection approach allows for clinical applications in EFTR of gastric submucosal tumors.
内镜全层切除术（EFTR）后胃壁缺损的完全闭合至关重要。本研究的目的是评估一种新的内镜方法——边剥离边闭合的疗效、安全性及临床结果。
回顾性分析2020年1月至2021年3月期间接受EFTR的27例患者。使用内镜夹采用“剥离过程中间断闭合”技术闭合EFTR导致的胃缺损。评估肿瘤特征、整块切除率及术后不良事件。
所有黏膜下肿瘤均成功切除，组织学证实为完整切除。肿瘤平均最大直径为1.3厘米（范围为0.8至3.0厘米）。这些肿瘤大多数为胃肠道间质瘤（n = 20）、平滑肌瘤（n = 3）、神经鞘瘤（n = 2），其他包括纤维瘤（n = 1）和神经源性肿瘤（n = 1）。无出血、腹膜炎或延迟穿孔病例。4例患者主诉轻微腹痛，但治疗后24小时内未检测到高热或白细胞计数严重升高。术后3个月随访内镜检查时所有伤口均愈合。平均随访时间为8.5个月（范围为3至17个月），未观察到肿瘤复发。
这种边剥离边间断闭合方法的可行性和安全性使其可应用于胃黏膜下肿瘤的EFTR临床治疗。
