Skip to main content

Advertisement

SpringerLink
Log in

Usefulness of the thread-traction method in endoscopic full-thickness resection for gastric submucosal tumor: a comparative study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic full-thickness resection (EFTR) has shown great prospects in treating gastric submucosal tumors (SMTs) from the muscularis propria. However, it is very difficult sometimes to ideally expose the tumor and gain adequate visualization for the dissection site. In the present study, we applied the thread-traction (TT) method to assist EFTR in treating gastric SMTs and investigated the feasibility and effectiveness of this strategy.

Methods

A total of 28 patients were involved in the study. 13 patients were treated by TT-assisted EFTR (TT group) and the others by non-assisted EFTR (NA group). Data on clinical characteristics and therapeutic outcomes were collected for analysis.

Results

The average tumor size was 1.6 ± 0.4 cm. En bloc resection rate was 92.9%. Histopathological evaluation indicated that 22 tumors were gastrointestinal stromal tumors (78.6%), all at low- or very low-risk, and 6 tumors were leiomyomas (21.4%). The total complication rate was 32.1%. All complications were managed intra-operatively or conservatively. Both the total procedure time and the perforation time were significantly shorter in patients of TT group than those of NA group (71.9 ± 30.5 vs. 107.5 ± 35.8 min, P = 0.010; 38.3 ± 22.0 vs. 68.6 ± 24.2 min, P = 0.002). The pain score evaluated by visual analogue system after operation was significantly lower in patients of TT group than those of NA group (4.5 ± 1.1 vs. 5.8 ± 1.4, P = 0.014). Although complication rate was lower in patients of TT group than those of NA group, the difference was not statistically significant (15.4% vs. 46.7%, P = 0.114). No residual or recurrent tumors were observed during a mean follow-up period of 17.9 ± 4.4 months.

Conclusions

The TT method could effectively assist EFTR to shorten operation time and decrease the risk of complications.

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

Similar content being viewed by others

References

  1. Ikeda K, Mosse CA, Park PO, Fritscher-Ravens A, Bergström M, Mills T, Tajiri H, Swain CP (2006) Endoscopic full-thickness resection: circumferential cutting method. Gastrointest Endosc 64(1):82–89

    Article  PubMed  Google Scholar 

  2. Zhang Y, Wang X, Xiong G, Qian Y, Wang H, Liu L, Miao L, Fan Z (2014) Complete defect closure of gastric submucosal tumors with purse-string sutures. Surg Endosc 28(6):1844–1851

    Article  PubMed  Google Scholar 

  3. Wang J, Zhao L, Wang X, Liu L, Wang M, Fan Z (2017) A novel endoloop system for closure of colonic mucosal defects through a single-channel colonoscope. Endoscopy 49:803–807

    Article  PubMed  Google Scholar 

  4. Shi Q, Chen T, Zhong YS, Zhou PH, Ren Z, Xu MD, Yao LQ (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  PubMed  Google Scholar 

  5. Schmidt A, Meier B, Caca K (2015) Endoscopic full-thickness resection: current status. World J Gastroenterol 21:9273–9285

    Article  PubMed  PubMed Central  Google Scholar 

  6. Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, Atomi Y (2009) Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 23:1908–1913

    Article  PubMed  Google Scholar 

  7. Mori H, Rahman A, Kobara H, Fujihara S, Nishiyama N, Ayaki M, Matsunaga T, Murakami M, Masaki T (2017) Current status of exposed endoscopic full-thickness resection and further development of non-exposed endoscopic full-thickness resection. Digestion 95:6–15

    Article  PubMed  Google Scholar 

  8. Goto O, Takeuchi H, Sasaki M, Kawakubo H, Akimoto T, Fujimoto A, Ochiai Y, Maehata T, Nishizawa T, Kitagawa Y, Yahagi N (2016) Laparoscopy-assisted endoscopic full-thickness resection of gastric subepithelial tumors using a none exposure technique. Endoscopy 48:1010–1015

    Article  PubMed  Google Scholar 

  9. Wang H, Tan Y, Zhou Y, Wang Y, Li C, Zhou J, Duan T, Zhang J, Liu D (2015) Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol 27:776–780

    Article  PubMed  Google Scholar 

  10. Tan ES, Wang H, Lua GW, Liu F, Shi XG, Li ZS (2016) Fibrin glue spray as a simple and promising method to prevent bleeding after gastric endoscopic submucosal dissection. Dig Surg 33:455–461

    Article  CAS  PubMed  Google Scholar 

  11. Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw Suppl2:S1–S41

    Google Scholar 

  12. Hwang JH, Rulyak SD, Kimmey MB (2006) American Gastroenterological Association Institute. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 130:2217–2228

    Article  PubMed  Google Scholar 

  13. Koga T, Hirayama Y, Yoshiya S, Taketani K, Nakanoko T, Yoshida R, Minagawa R, Kai M, Kajiyama K, Akahoshi K, Maehara Y (2015) Necessity for resection of gastric gastrointestinal stromal tumors ≤ 20 mm. Anticancer Res 35:2341–2344

    PubMed  Google Scholar 

  14. Yang J, Feng F, Li M, Sun L, Hong L, Cai L, Wang W, Xu G, Zhang H (2013) Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors. World J Surg Oncol 11:273

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wang H, Feng X, Ye S, Wang J, Liang J, Mai S, Lai M, Feng H, Wang G, Zhou Y (2016) A comparison of the efficacy and safety of endoscopic full-thickness resection and laparoscopic-assisted surgery for small gastrointestinal stromal tumors. Surg Endosc 30:3357–3361

    Article  PubMed  Google Scholar 

  16. Dong HY, Wang YL, Jia XY, Li J, Li GD, Li YQ (2014) Modified laparoscopic intragastric surgery and endoscopic full-thickness resection for gastric stromal tumor originating from the muscularis propria. Surg Endosc 28:1447–1453

    Article  PubMed  Google Scholar 

  17. Yoshida M, Takizawa K, Ono H, Igarashi K, Sugimoto S, Kawata N, Tanaka M, Kakushima N, Ito S, Imai K, Hotta K, Matsubayashi H (2016) Efficacy of endoscopic submucosal dissection with dental floss clip traction for gastric epithelial neoplasia: a pilot study (with video). Surg Endosc 30:3100–3106

    Article  PubMed  Google Scholar 

  18. Li CH, Chen PJ, Chu HC, Huang TY, Shih YL, Chang WK, Hsieh TY (2011) Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). Gastrointest Endosc 73:163–167

    Article  PubMed  Google Scholar 

  19. Noda H, Ogasawara N, Koshino A, Fukuta S, Nagoya T, Hoshino H, Nagao K, Sugiyama T, Kondo Y, Ito Y, Izawa S, Ebi M, Funaki Y, Sasaki M, Kasugai K (2016) Thread-traction with a sheath of polypectomy snare facilitates endoscopic submucosal dissection of early gastric cancers. Gastroenterol Res Pract 2016:9415497

    Article  PubMed  Google Scholar 

  20. Suzuki S, Gotoda T, Kobayashi Y, Kono S, Iwatsuka K, Yagi-Kuwata N, Kusano C, Fukuzawa M, Moriyasu F (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  PubMed  Google Scholar 

  21. Koike Y, Hirasawa D, Fujita N, Maeda Y, Ohira T, Harada Y, Suzuki K, Yamagata T, Tanaka M (2015) Usefulness of the thread-traction method in esophageal endoscopic submucosal dissection: randomized controlled trial. Dig Endosc 27:303–309

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by grants from National Nature Science Foundation of China (No. 81670604).

Author information

Author notes

  1. Jun Li, Yuting Meng and Shufang Ye have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

    Jun Li, Yuting Meng & Peng Wang

  2. Department of Gastroenterology, Lishui People’s Hospital, Lishui, Zhejiang, China

    Shufang Ye

  3. Digestive Endoscopy Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Mid Yanchang Road, Shanghai, 200072, China

    Feng Liu

Authors
  1. Jun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuting Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shufang Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Feng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design (FL); acquisition, analysis and interpretation of data (JL, YM, SY); drafting of the manuscript (JL, YM); critical revision of the manuscript for important intellectual content (FL); technical or material support (SY, PW, FL); study supervision (FL). The article has been approved by all authors to be published.

Corresponding author

Correspondence to Feng Liu.

Ethics declarations

Disclosure

Drs. Jun Li, Yuting Meng, Shufang Ye, Peng Wang and Feng Liu stated that they do not have any conflict of interests or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, J., Meng, Y., Ye, S. et al. Usefulness of the thread-traction method in endoscopic full-thickness resection for gastric submucosal tumor: a comparative study. Surg Endosc 33, 2880–2885 (2019). https://doi.org/10.1007/s00464-018-6585-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6585-2

Keywords

Search

Navigation