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Comparison of endoscopic full-thickness resection and ligation-assisted endoscopic full-thickness resection for small (≤ 1.5 cm) gastric subepithelial tumors originating from muscularis propria

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Abstract

Background

In the treatment of small gastric subepithelial tumors originating from muscularis propria (SET-MPs), endoscopic full-thickness resection (EFTR) has been an effective procedure and ligation-assisted EFTR (EFTR-L) seems a feasible and promising operation. We aimed to compare the therapeutic outcomes of EFTR-L and EFTR to evaluate effect and safety of either method in the treatment of small (≤ 1.5 cm) gastric SET-MPs.

Methods

Between January 2018 to May 2022, we retrospectively enrolled a total of 119 patients with gastric SET-MPs treated by EFTR-L (79 patients) or EFTR (40 patients) at Xiangya Hospital Central South University. Clinical characteristics, operation efficacy, adverse events (AEs), and operation cost were compared between the 2 groups. Univariate and multiple logistic and linear regressions were applied to analyze the therapeutic outcomes of the procedure, and covariates were adjusted in the multiple analysis.

Results

The operation time of EFTR-L group (16.34 ± 5.75 min) was significantly shorter than EFTR group (51.23 ± 21.21 min, P < 0.001), and the difference remained significant after adjusting the covariates (adjusted mean difference, 30.56; 95% confidence interval, 25.65–35.47; P < 0.001). The operation cost of EFTR-L group was lower than EFTR group (1268.52 ± 457.22 vs 1643.18 ± 295.08 $; P < 0.001). The complete resection rate of the EFTR-L group was 98.72% and of the EFTR group 100%. The incidence of abdominal pain in the EFTR-L group (5.06%) was lower than in the EFTR group (27.50%, P = 0.008). A patient in the EFTR group underwent severe pneumoperitoneum and received abdominocentesis during operation. One case of peritonitis occurred in the EFTR-L group but recovered from intensified antibiotic therapy. No delayed blood or perforation occurred.

Conclusions

Compared to EFTR, EFTR-L might be a feasible procedure for small (≤ 1.5 cm) gastric SET-MPs due to the acceptable efficacy, shorter operation time, and lower cost.

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Acknowledgements

This project was supported by Appropriate Technology Promotion Project of National Clinical Research Center for Geriatric Disorders (Xiangya Hospital) (XYYYJSTG-11). No other funding organization played a role in the design or conduct of the study, the collection, management, analysis, or interpretation of the data, or the preparation, review, or approval of the manuscript. We thank Ms. Menglin Gu (Department of Visual Communication, College of Art and Design, Hunan First Normal University) for drawing schematic diagram.

Funding

This work was supported by grant funded by National Research Center of Geriatric Diseases (Xiangya Hospital of Central South University) (XYYYJSTG-11). No other funding organization played a role in the design or conduct of the study, the collection, management, analysis, or interpretation of the data, or the preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Lei Gu, Yu Wu, Jun Yi, Miao Ouyang & Xiaowei Liu

  2. Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease (2020CB1004), Changsha, Hunan, China

    Xiaowei Liu

  3. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Xiaowei Liu

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  1. Lei Gu
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Contributions

LG, YW, and XL: designed the study; LG and YW: collected data of patients and performed follow-up visit; LG: analyzed data and wrote the manuscript; MO and JY revised the manuscript; YW and XL: modified the manuscript critically. All authors approved the final version of the manuscript.

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Correspondence to Yu Wu or Xiaowei Liu.

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Authors Lei Gu, Yu Wu, Jun Yi, Miao Ouyang, and Xiaowei Liu have no conflicts of interest or financial ties to disclose.

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Gu, L., Wu, Y., Yi, J. et al. Comparison of endoscopic full-thickness resection and ligation-assisted endoscopic full-thickness resection for small (≤ 1.5 cm) gastric subepithelial tumors originating from muscularis propria. Surg Endosc 37, 3796–3806 (2023). https://doi.org/10.1007/s00464-023-09881-3

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