Skip to main content

Advertisement

SpringerLink
Log in

The efficacy of dental floss and a hemoclip as a traction method for the endoscopic full-thickness resection of submucosal tumors in the gastric fundus

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic full-thickness resection (EFTR) provides a significant advancement to the treatment of gastrointestinal submucosal tumors (SMTs). However, technological challenges, particularly in the gastric fundus, hinder its wider application. Here, we investigated the efficacy of a simple traction method that used dental floss and a hemoclip (DFC) to facilitate EFTR.

Methods

Between July 2014 and December 2016, we retrospectively reviewed data from all patients with SMTs in the gastric fundus originating from the muscularis propria layer that were treated by EFTR at Zhongshan Hospital of Fudan University. Baseline characteristics and clinical outcomes, including procedure time and complications rate, were compared between groups of patients receiving DFC–EFTR and conventional EFTR.

Results

A total of 192 patients were included in our analysis (64 in the DFC–EFTR group and 128 in the conventional EFTR group). Baseline characteristics for the two groups were similar. The mean time for DFC–EFTR and conventional EFTR was 44.2 ± 24.4 and 54.2 ± 33.2 min, respectively (P = 0.034). Although no serious adverse events presented in any of our cases, post-EFTR electrocoagulation syndrome (PEECS), as a minor complication, was less frequent in the DFC–EFTR group (3.1% vs. 12.5%, P = 0.036). Univariate and multivariate analysis identified that DFC, when used in EFTR, played a significant role in reducing procedure time and the rate of PEECS. The mean procedure time was significantly shorter in the DFC–EFTR group for lesions over 1.0 cm (P = 0.005), when the lesions were located in the greater curvature of the gastric fundus (P = 0.025) or when the lesions presented with intraluminal growth (P = 0.032). Moreover, when EFTR was carried out by experts, the mean procedure time was 20.4% shorter in the DFC–EFTR group (P = 0.038).

Conclusions

This study indicated that DFC–EFTR for SMTs in the gastric fundus resulted in a shorter procedure time and reduced the risk of PEECS, a minor complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cai MY et al (2018) Endoscopic full-thickness resection for gastrointestinal submucosal tumors. Dig Endosc 30(Suppl 1):17–24

    Article  Google Scholar 

  2. Li QL et al (2012) Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc 75:1153–1158

    Article  Google Scholar 

  3. An W et al (2017) Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surg Endosc 31:4522–4531

    Article  Google Scholar 

  4. Schmidt A et al (2015) Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series. Endoscopy 47:154–158

    PubMed  Google Scholar 

  5. Sarker S et al (2014) Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 46:758–761

    Article  Google Scholar 

  6. Zhou PH et al (2011) Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25:2926–2931

    Article  Google Scholar 

  7. Cai SL et al (2015) Dental floss traction assists in treating gastrointestinal mucosal tumors by endoscopy. J Laparoendosc Adv Surg Tech A 25:571–576

    Article  Google Scholar 

  8. Shi Q et al (2018) Clinical values of dental floss traction assistance in endoscopic full-thickness resection for submucosal tumors originating from the muscularis propria layer in the gastric fundus. J Laparoendosc Adv Surg Tech A 28:1261–1265

    Article  Google Scholar 

  9. Shi Q et al (2013) Complete closure of large gastric defects after endoscopic full-thickness resection, using endoloop and metallic clip interrupted suture. Endoscopy 45:329–334

    Article  CAS  Google Scholar 

  10. Chen T et al (2017) Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg 265:363–369

    Article  Google Scholar 

  11. Chen W et al (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66:115–132

    Article  Google Scholar 

  12. Dupart J et al (2011) Gastrointestinal stromal tumor and its targeted therapeutics. Chin J Cancer 30:303–314

    Article  CAS  Google Scholar 

  13. Qi ZP et al (2018) Efficacy and safety of endoscopic submucosal dissection for submucosal tumors of the colon and rectum. Gastrointest Endosc 87(540–548):e541

    Google Scholar 

  14. Kopelman Y et al (2012) Endoscopic full-thickness GI wall resection: current status. Gastrointest Endosc 75:165–173

    Article  Google Scholar 

  15. Li L et al (2013) Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria. Exp Ther Med 6:391–395

    Article  Google Scholar 

  16. Qiao WG et al (2015) Cap-aspiration lumpectomy for small submucosal tumors originating from the muscularis propria of the gastric fundus: a preliminary study (with videos). J Dig Dis 16:642–648

    Article  Google Scholar 

  17. Jeon WJ et al (2009) A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection. Gastrointest Endosc 69:29–33

    Article  Google Scholar 

  18. Li CH et al (2011) Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). Gastrointest Endosc 73:163–167

    Article  Google Scholar 

  19. Suzuki S et al (2016) Usefulness of a traction method using dental floss and a hemoclip for gastric endoscopic submucosal dissection: a propensity score matching analysis (with videos). Gastrointest Endosc 83:337–346

    Article  Google Scholar 

  20. Yoshida M et al (2018) Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 87:1231–1240

    Article  Google Scholar 

  21. Li J et al (2018) Usefulness of the thread-traction method in endoscopic full-thickness resection for gastric submucosal tumor: a comparative study. Surg Endosc. https://doi.org/10.1007/s00464-018-6585-2

    Article  PubMed  PubMed Central  Google Scholar 

  22. Yang F et al (2015) Factors associated with endoscopic full-thickness resection of gastric submucosal tumors. Surg Endosc 29:3588–3593

    Article  Google Scholar 

  23. Lee H et al (2012) Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm. Gastric Cancer 15:83–90

    Article  Google Scholar 

  24. Lee SP et al (2017) A randomized controlled trial of prophylactic antibiotics in the prevention of electrocoagulation syndrome after colorectal endoscopic submucosal dissection. Gastrointest Endosc 86(349–357):e342

    Google Scholar 

  25. Jung D et al (2013) Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endoscopy 45:714–717

    Article  Google Scholar 

  26. Goto O et al (2016) Laparoscopy-assisted endoscopic full-thickness resection of gastric subepithelial tumors using a nonexposure technique. Endoscopy 48:1010–1015

    Article  Google Scholar 

  27. Mori H et al (2014) Balloon-armed mechanical counter traction and double-armed bar suturing systems for pure endoscopic full-thickness resection. Gastroenterology 147(278–280):e271

    Google Scholar 

  28. Aihara H et al (2014) A novel magnetic countertraction device for endoscopic submucosal dissection significantly reduces procedure time and minimizes technical difficulty. Endoscopy 46:422–425

    Article  Google Scholar 

  29. Dobashi A et al (2018) Endoscopic full-thickness resection using suture loop needle T-tag tissue anchors in the porcine stomach (with video). Gastrointest Endosc 87:590–596

    Article  Google Scholar 

Download references

Funding

This project was supported by the Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy (16DZ2280900), the National Natural Science Foundation of China (81672329), the Shanghai Municipal Health System Outstanding Academic Leaders Foundation Program (2017BR010), and the Jianfeng Project of Xuhui Provincial Commission of Health and Family Planning (SHXH201701). The funders had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.

Author information

Author notes

  1. Bing Li, Qiang Shi, and Zhi-Peng Qi contributed equally to this paper.

Authors and Affiliations

  1. Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China

    Bing Li, Qiang Shi, Zhi-Peng Qi, Li-Qing Yao, Mei-Dong Xu, Zhen-Tao Lv, Ayimukedisi Yalikong, Shi-Lun Cai, Di Sun, Ping-Hong Zhou & Yun-Shi Zhong

  2. Endoscopy Research Institute of Fudan University, Shanghai, 200032, China

    Bing Li, Qiang Shi, Zhi-Peng Qi, Li-Qing Yao, Mei-Dong Xu, Zhen-Tao Lv, Ayimukedisi Yalikong, Shi-Lun Cai, Di Sun, Ping-Hong Zhou & Yun-Shi Zhong

Authors
  1. Bing Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qiang Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhi-Peng Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li-Qing Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mei-Dong Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhen-Tao Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ayimukedisi Yalikong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shi-Lun Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Di Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ping-Hong Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yun-Shi Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Ping-Hong Zhou or Yun-Shi Zhong.

Ethics declarations

Disclosures

Bing Li, Qiang Shi, Zhi-Peng Qi, Li-Qing Yao, Mei-Dong Xu, Zhen-Tao Lv, Ayimukedisi Yalikong, Shi-Lun Cai, Di Sun, Ping-Hong Zhou, and Yun-Shi Zhong have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

EFTR procedures assisted by DFC. EFTR, endoscopic full-thickness resection; DFC, dental floss and a hemoclip. (MP4 69986 kb)

Key operating steps in the conventional EFTR group. EFTR, endoscopic full-thickness resection. (MP4 47240 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, B., Shi, Q., Qi, ZP. et al. The efficacy of dental floss and a hemoclip as a traction method for the endoscopic full-thickness resection of submucosal tumors in the gastric fundus. Surg Endosc 33, 3864–3873 (2019). https://doi.org/10.1007/s00464-019-06920-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06920-w

Keywords

Search

Navigation