Liu Shuxi, Chen Zhukai, He Lingnan, Xu Aiping, Zhang Zehua, Du Xiaojing, Yang Shuangzhu, Zhang Haibing, Zhang Li, Lian Jingjing, Xu Meidong, Chen Tao
Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China .
Clin Transl Gastroenterol. 2025 Jun 13;16(8):e00869. doi: 10.14309/ctg.0000000000000869. eCollection 2025 Aug 1.
The new working submucosal tunnel space allows entry to deeper layers of the luminal wall or even entirely outside the gastrointestinal tract for the treatment of submucosal tumors. Based on this concept, we developed submucosal tunneling endoscopic resection (STER). Here, we compared the clinical outcomes between exposed endoscopic full-thickness resection (EFTR) and STER (nonexposed EFTR) and analyzed the efficacy and safety of Natural Orifice Transluminal Endoscopic Surgery (NOTES) based on STER for extra-gastrointestinal stromal tumors (EGISTs).
Sixty consecutive patients with tumors in the lesser curvature of the stomach corpus were enrolled from July 2019 to December 2023. Data on clinicopathologic features, treatment results, and follow-up outcomes were collected and analyzed retrospectively.
Among the 60 patients, 31 patients underwent EFTR and 29 patients underwent STER. The EFTR group had a shorter procedure time ( P = 0.016) but a longer postoperative hospital stay ( P = 0.004) than the STER group. Tumor size > 2 cm and endoloop-clips suture were significantly associated with long-time procedure. NOTES based on STER was successful for EGISTs. Follow-up data from 6 to 60 months was collected with no loss. All patients were free from local recurrence and distant metastasis during the study period.
Although the procedure time of STER is longer than that of EFTR, the postoperative hospital stay is shorter. Tumor size > 2 cm and use of endoloop-clips suture are significantly associated with long-time procedure. In addition, STER-based NOTES is a promising and safe methodology for the resection of EGISTs.
新的工作黏膜下隧道空间允许进入管腔壁的更深层，甚至完全进入胃肠道外，用于治疗黏膜下肿瘤。基于这一概念，我们开发了黏膜下隧道内镜切除术（STER）。在此，我们比较了暴露式内镜全层切除术（EFTR）和STER（非暴露式EFTR）的临床结果，并分析了基于STER的经自然腔道内镜手术（NOTES）治疗胃肠道外间质瘤（EGIST）的疗效和安全性。
2019年7月至2023年12月连续纳入60例胃体小弯侧肿瘤患者。回顾性收集并分析临床病理特征、治疗结果和随访结果的数据。
60例患者中，31例行EFTR，29例行STER。EFTR组手术时间短于STER组（P = 0.016），但术后住院时间长于STER组（P = 0.004）。肿瘤大小>2 cm和使用内镜圈套器缝合与手术时间长显著相关。基于STER的NOTES治疗EGIST成功。收集了6至60个月的随访数据，无失访。研究期间所有患者均无局部复发和远处转移。
虽然STER的手术时间比EFTR长，但术后住院时间短。肿瘤大小>2 cm和使用内镜圈套器缝合与手术时间长显著相关。此外，基于STER的NOTES是一种有前景且安全的EGIST切除方法。
