Advertisement

Submucosal Surgery: Pyloromyotomy and Tumor Enucleation

  • Eran Shlomovitz
  • Oscar M. Crespin
Chapter

Abstract

Spurred by advances in endoscopic imaging, instrumentation, and energy devices, therapeutic endoscopic techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have gained popularity and mainstream acceptance. Experience gained with these procedures in combination with the interest in natural orifice transluminal endoscopic surgery (NOTES) led to the development of the peroral endoscopic myotomy (POEM) procedure. The POEM procedure for the treatment of achalasia and other spastic esophageal disorder has quickly become the most successful and widely adopted NOTES procedure. The worldwide acceptance of POEM stimulated endoscopists to expand the techniques of operating in the submucosal space. In this chapter we aim to describe the techniques of endoscopic submucosal tumor enucleation, peroral pyloromyotomy (POP), as well as future trends in the field.

References

  1. 1.
    Tada M, Murata M, Murakami F, et al. Development of the strip-off biopsy (in Japanese). Gastrointest Endosc. 1984;26:833–9.Google Scholar
  2. 2.
    Rosenberg N. Submucosal saline wheal as a safety factor in fulguration of rectal and sigmoid polyps. Arch Surg. 1955;70:120–3.CrossRefGoogle Scholar
  3. 3.
    Park Y, Jeon TJ, Park JY, et al. Comparison of clipping with and without epinephrine injection for the prevention of post-polypectomy bleeding in pedunculated colon polyps. J Gastroenterol Hepatol. 2015;30:1499–506.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee S-H, Chung I-K, Kim S-J, Kim J-O, Ko B-M, Kim WH, Kim H-S, Park D-I, Kim H-J, Byeon J-S, Yang S-K, Jang BI, Jung S-A, Jeen Y-T, Choi J-H, Choi H, Han D-S, Song JS. Comparison of postpolypectomy bleeding between epinephrine and saline submucosal injection for large colon polyps by conventional polypectomy: a prospective randomized, multicenter study. World J Gastroenterol. 2007;13:2973–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Corte CJ, Burger DC, Horgan G, et al. Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasisu or epinephrine: a meta-analysis. United European Gastroenterol J. 2014;2:123–30.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lee SH, Lee KS, Park YS, et al. Submucosal saline-epinephrine injection in colon polypectomy: appropriate indication. Hepato-Gastroenterology. 2008;55:1589–93.PubMedGoogle Scholar
  7. 7.
    Muto M, Miyamoto S, Hosokawa A, et al. Endoscopic mucosal resection in the stomach using the insulated-tip needle-knife. Endoscopy. 2005;37:178–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Inoue H, Endo M, Takeshita K, et al. A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC). Surg Endosc. 1992;6:264–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Larghi A, Waxman I. State of the art on endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc Clin N Am. 2007;17:441–69, v.CrossRefPubMedGoogle Scholar
  10. 10.
    Feitoza AB, Gostout CJ, Burgart LJ, et al. Hydroxypropyl methylcellulose: a better submucosal fluid cushion for endoscopic mucosal resection. Gastrointest Endosc. 2003;57:41–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Fujishiro M, Yahagi N, Kashimura K, et al. Tissue damage of different submucosal injection solutions for EMR. Gastrointest Endosc. 2005;62:933–42.CrossRefPubMedGoogle Scholar
  12. 12.
    Fujishiro M, Yahagi N, Nakamura M, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc. 2006;63:243–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Yamamoto H, Yube T, Isoda N, et al. A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc. 1999;50:251–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Sato T. A novel method of endoscopic mucosal resection assisted by submucosal injection of autologous blood (blood patch EMR). Dis Colon Rectum. 2006;49:1636–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Soetikno RM, Gotoda T, Nakanishi Y, et al. Endoscopic mucosal resection. Gastrointest Endosc. 2003;57:567–79.CrossRefPubMedGoogle Scholar
  16. 16.
    Hoda KM, Rodriguez SA, Faigel DO. EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc. 2009;69:1218–23.CrossRefPubMedGoogle Scholar
  17. 17.
    Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy. 2016;48(4):339–49.PubMedGoogle Scholar
  18. 18.
    Ye LP, Zhang Y, Mao XL, et al. Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc. 2014;28:524–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Miettinen M, Monihan JM, Sarlomo-Rikala M, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery: clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol. 1999;23:1109–18.CrossRefPubMedGoogle Scholar
  20. 20.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1–12.CrossRefPubMedGoogle Scholar
  21. 21.
    Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol. 1999;30:1213–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Reith JD, Goldblum JR, Lyles RH, et al. Extragastrointestinal (soft tissue) stromal tumors: an analysis of 48 cases with emphasis on histologic predictors of outcome. Mod Pathol. 2000;13:577–85.CrossRefPubMedGoogle Scholar
  23. 23.
    Li QL, Zhong YS, Zhou PH, et al. [Therapeutic value of endoscopic submucosal dissection for gastrointestinal stromal tumor in the esophagogastric junction]. Zhonghua Wei Chang Wai Ke Za Zhi. 2012;15:236–9.Google Scholar
  24. 24.
    Mou Y, Wu C, Yi H, et al. A case report: endoscopic enucleation of gastrointestinal stromal tumor of the ampulla of Vater. Clin J Gastroenterol. 2013;6:198–201.CrossRefPubMedGoogle Scholar
  25. 25.
    Jakob J, Mussi C, Ronellenfitsch U, et al. Gastrointestinal stromal tumor of the rectum: results of surgical and multimodality therapy in the era of imatinib. Ann Surg Oncol. 2013;20:586–92.CrossRefPubMedGoogle Scholar
  26. 26.
    Hiki N, Yamamoto Y, Fukunaga T, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc. 2008;22:1729–35.CrossRefPubMedGoogle Scholar
  27. 27.
    Namikawa T, Hanazaki K. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor. World J Gastrointest Endosc. 2015;7:1150–6.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Chen T, Zhang C, Yao LQ, et al. Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Endoscopy. 2016;48(2):149–55.PubMedGoogle Scholar
  29. 29.
    Tsujii Y, Nishida T, Nishiyama O, et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy. 2015;47:775–83.CrossRefPubMedGoogle Scholar
  30. 30.
    Probst A, Maerkl B, Bittinger M, et al. Gastric ischemia following endoscopic submucosal dissection of early gastric cancer. Gastric Cancer. 2010;13:58–61.CrossRefPubMedGoogle Scholar
  31. 31.
    Cheng YC, Wu CC, Lee CC, et al. Rare complication following screening colonoscopy: ischemic colitis. Dig Endosc. 2012;24:379.CrossRefPubMedGoogle Scholar
  32. 32.
    Tsunada S, Ogata S, Mannen K, et al. Case series of endoscopic balloon dilation to treat a stricture caused by circumferential resection of the gastric antrum by endoscopic submucosal dissection. Gastrointest Endosc. 2008;67:979–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Ohara Y, Toyonaga T, Tanaka S, et al. Risk of stricture after endoscopic submucosal dissection for large rectal neoplasms. Endoscopy. 2016;48(1):62–70.PubMedGoogle Scholar
  34. 34.
    Ortega JA, Madureri V, Perez L. Endoscopic myotomy in the treatment of achalasia. Gastrointest Endosc. 1980;26:8–10.CrossRefPubMedGoogle Scholar
  35. 35.
    Pasricha PJ, Hawari R, Ahmed I, et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy. 2007;39:761–4.CrossRefPubMedGoogle Scholar
  36. 36.
    Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.CrossRefPubMedGoogle Scholar
  37. 37.
    Sharata AM, Dunst CM, Pescarus R, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg. 2015;19:161–70. Discussion 170.CrossRefPubMedGoogle Scholar
  38. 38.
    Onimaru M, Inoue H, Ikeda H, et al. Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study. J Am Coll Surg. 2013;217:598–605.CrossRefPubMedGoogle Scholar
  39. 39.
    Hu JW, Li QL, Zhou PH, et al. Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc. 2015;29(9):2841–50.CrossRefPubMedGoogle Scholar
  40. 40.
    Shiwaku H, Inoue H, Beppu R, et al. Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy. Gastrointest Endosc. 2013;77:149–50.CrossRefPubMedGoogle Scholar
  41. 41.
    Swanstrom LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg. 2011;213:751–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Camilleri M. Clinical practice. Diabetic gastroparesis. N Engl J Med. 2007;356:820–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Jung HK, Choung RS, Locke III GR, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–33.CrossRefPubMedGoogle Scholar
  44. 44.
    Wang YR, Fisher RS, Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004. Am J Gastroenterol. 2008;103:313–22.CrossRefPubMedGoogle Scholar
  45. 45.
    Grover M, Farrugia G, Lurken MS, et al. Cellular changes in diabetic and idiopathic gastroparesis. Gastroenterology. 2011;140:1575–85.e8.CrossRefPubMedGoogle Scholar
  46. 46.
    Soykan I, Sivri B, Sarosiek I, et al. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43:2398–404.CrossRefPubMedGoogle Scholar
  47. 47.
    Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1589–91.CrossRefPubMedGoogle Scholar
  48. 48.
    Hibbard ML, Dunst CM, Swanstrom LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg. 2011;15:1513–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Kawai M, Peretta S, Burckhardt O, et al. Endoscopic pyloromyotomy: a new concept of minimally invasive surgery for pyloric stenosis. Endoscopy. 2012;44:169–73.CrossRefPubMedGoogle Scholar
  50. 50.
    Khashab MA, Stein E, Clarke JO, et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2013;78:764–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Shlomovitz E, Pescarus R, Cassera MA, et al. Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc. 2015;29:543–51.CrossRefPubMedGoogle Scholar
  52. 52.
    Chung H, Dallemagne B, Perretta S, et al. Endoscopic pyloromyotomy for postesophagectomy gastric outlet obstruction. Endoscopy. 2014;46 Suppl 1 UCTN:E345–6.Google Scholar
  53. 53.
    Chaves DM, de Moura EG, Mestieri LH, et al. Endoscopic pyloromyotomy via a gastric submucosal tunnel dissection for the treatment of gastroparesis after surgical vagal lesion. Gastrointest Endosc. 2014;80:164.CrossRefPubMedGoogle Scholar
  54. 54.
    Kurian AA, Dunst CM, Sharata A, et al. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77:719–25.CrossRefPubMedGoogle Scholar
  55. 55.
    Teitelbaum EN, Soper NJ, Arafat FO, et al. Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg. 2014;18:92–8. Discussion 98–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Patel KS, Calixte R, Modayil RJ, et al. The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc. 2015;81:1181–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of General SurgeryUniversity Health NetworkTorontoCanada

Personalised recommendations