Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan.
Department of Surgery, Yokohama City University Medical Center, Yokohama, Japan.
Digestion. 2023;104(6):460-467. doi: 10.1159/000532012. Epub 2023 Aug 30.
Endoscopic full-thickness resection (EFTR) without laparoscopic assistance (pure EFTR) is an emerging, less invasive treatment for gastrointestinal stromal tumors (GISTs). However, the technique has seldom been performed outside China because of concerns regarding pneumoperitoneum, maintenance of endoscopic view, and endoscopic suturing. This study aimed to evaluate the efficacy and safety of endoscopic resection with one-port placement (EROPP) for gastric GISTs.
This retrospective study included 17 patients with gastric GISTs originating from the muscularis propria who underwent EROPP between 2019 and 2022. One camera port was inserted in the umbilicus before initiating the endoscopic procedure to maintain intra-abdominal pressure, which was monitored and adjusted via this port. While allowing for conversion to laparoscopic surgery if needed, EFTR was performed as follows: (1) circumferential incision of the mucosal and submucosal layers around the lesion was performed by typical endoscopic submucosal dissection; (2) an intentional perforation and subsequent seromuscular resection was made using dental floss and an endo-clip for traction; and (3) closure of the gastric full-thickness defect was performed with an over-the-scope clip (OTSC) after peroral retrieval of the specimen. We retrospectively assessed the short-term outcomes and safety.
All procedures were completed successfully without conversion to laparoscopic surgery. The median size of the resected tumors was 23 mm (range, 8-35 mm), the median resection time was 36 min (range, 22-95 min), and closure time was 18 min (range, 10-45 min). The rates of en bloc and complete resection were 100% and 88%, respectively. In 2 cases, another port was added to aspirate the leaking fluid or check the condition of the endoscopic closure. All gastric defects were endoscopically closed, mainly using OTSCs. The recovery course for all patients was uneventful, and no adverse events were reported.
EROPP is a safe and minimally invasive treatment for gastric GISTs and appears to be suitable for introducing EFTR procedures.
内镜全层切除术（EFTR）无需腹腔镜辅助（纯 EFTR）是一种新兴的、微创的胃肠道间质瘤（GIST）治疗方法。然而，由于对气腹、内镜视野维持和内镜缝合的担忧，该技术在中国以外很少应用。本研究旨在评估内镜单孔置管（EROPP）胃 GIST 切除术的疗效和安全性。
本回顾性研究纳入了 2019 年至 2022 年期间接受 EROPP 治疗的 17 例起源于固有肌层的胃 GIST 患者。在开始内镜手术前，在脐部插入一个摄像端口以维持腹腔内压力，通过该端口监测和调整压力。在允许必要时转为腹腔镜手术的同时，EFTR 如下进行：（1）通过典型的内镜黏膜下剥离术在病变周围的黏膜和黏膜下层进行环形切开；（2）使用牙线和内镜夹进行人为穿孔和随后的浆肌层切除以进行牵引；（3）标本经口取出后，用经内镜推送的夹（OTSC）闭合胃全层缺损。我们回顾性评估了短期结果和安全性。
所有手术均成功完成，无中转腹腔镜手术。切除肿瘤的中位大小为 23mm（范围 8-35mm），中位切除时间为 36 分钟（范围 22-95 分钟），闭合时间为 18 分钟（范围 10-45 分钟）。整块切除率和完全切除率分别为 100%和 88%。在 2 例中，另加一个端口以抽吸漏出的液体或检查内镜闭合情况。所有胃缺损均经内镜闭合，主要使用 OTSC。所有患者的恢复过程均顺利，无不良事件发生。
EROPP 是一种安全、微创的胃 GIST 治疗方法，似乎适合引入 EFTR 程序。
