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Endoscopic Full-Thickness Resection of Submucosal Gastric Tumors

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Abstract

Background and Aims

Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal lesions, such as early cancer or submucosal tumor. The aim of this pilot study was to evaluate a novel EFTR prototype device for full-thickness resection of the gastric wall containing artificial submucosal lesions.

Methods

Six artificial submucosal tumors were surgically created in the gastric submucosa by implanting 8-mm cork beads in anesthetized pigs. EFTR of the lesions was attempted using a prototype device which consists of a large transparent plastic cap, loaded onto the tip of the endoscope, into which the submucosal lesion and the surrounding gastrointestinal wall can be pulled by using suction, a grasping forceps, or a dedicated anchoring device. An over-the-scope clip (OTSC) can be deployed underneath the submucosal lesion and a pre-loaded snare is used for EFTR above the OTSC.

Results

The median procedure time was 15 min (interquartile range 11–22). Successful resection of the artificial submucosal lesion was achieved in 4/6 (67%) cases. Successful EFTR of the gastric wall was achieved in 3/6 (50%) cases. In all cases, the OTSC closed the EFTR site completely.

Conclusions

Gastric EFTR using the novel EFTR prototype device is feasible in a live animal model. The technique can achieve a full-thickness gastric wall and submucosal tumor resection with reliable closure of the gastric wall, but further refinements of the technique and device are necessary in order to reliably resect submucosal lesions, especially larger ones.

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Acknowledgment

Research funding (animal procedures and endotherapeutic material) was provided by Ovesco Endoscopy AG, Tübingen, Germany.

Conflict of interest

All authors declare that no conflict of interest related to this study exist.

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Authors and Affiliations

  1. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Daniel von Renteln, Thomas Rösch, Ulrike W. Denzer, Muhammad El-Masry & Guido Schachschal

  2. Department of Surgery, University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Thomas Kratt

Authors
  1. Daniel von Renteln
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  2. Thomas Rösch
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  3. Thomas Kratt
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  4. Ulrike W. Denzer
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  5. Muhammad El-Masry
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  6. Guido Schachschal
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Corresponding author

Correspondence to Daniel von Renteln.

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von Renteln, D., Rösch, T., Kratt, T. et al. Endoscopic Full-Thickness Resection of Submucosal Gastric Tumors. Dig Dis Sci 57, 1298–1303 (2012). https://doi.org/10.1007/s10620-012-2039-1

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  • DOI: https://doi.org/10.1007/s10620-012-2039-1

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