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.
Adult
Dental Devices, Home Care
Endoscopic Mucosal Resection
/ adverse effects
Female
Gastric Fundus
/ pathology
Gastroscopy
/ adverse effects
Humans
Male
Middle Aged
Outcome and Process Assessment, Health Care
Retrospective Studies
Stomach Neoplasms
/ pathology
Surgical Instruments
Treatment Outcome
Complications
Endoscopic full-thickness resection
Procedure time
Submucosal tumors
Traction methods
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
08
03
2019
accepted:
12
06
2019
pubmed:
4
8
2019
medline:
23
5
2020
entrez:
4
8
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31376013
doi: 10.1007/s00464-019-06920-w
pii: 10.1007/s00464-019-06920-w
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3864-3873Références
Chin J Cancer. 2011 May;30(5):303-14
pubmed: 21527063
Exp Ther Med. 2013 Aug;6(2):391-395
pubmed: 24137195
J Laparoendosc Adv Surg Tech A. 2015 Jul;25(7):571-6
pubmed: 25974169
Dig Endosc. 2018 Apr;30 Suppl 1:17-24
pubmed: 29658639
Surg Endosc. 2019 Sep;33(9):2880-2885
pubmed: 30456512
Endoscopy. 2013 Sep;45(9):714-7
pubmed: 23990482
Gastroenterology. 2014 Aug;147(2):278-80.e1
pubmed: 24973723
Gastrointest Endosc. 2009 Jan;69(1):29-33
pubmed: 19111686
Endoscopy. 2014 May;46(5):422-5
pubmed: 24573770
Gastrointest Endosc. 2018 Feb;87(2):590-596
pubmed: 28734991
Endoscopy. 2016 Nov;48(11):1010-1015
pubmed: 27448050
Gastrointest Endosc. 2011 Jan;73(1):163-7
pubmed: 21030018
Endoscopy. 2015 Feb;47(2):154-8
pubmed: 25380509
Surg Endosc. 2017 Nov;31(11):4522-4531
pubmed: 28374257
Gastrointest Endosc. 2017 Aug;86(2):349-357.e2
pubmed: 27899322
Gastrointest Endosc. 2012 Jun;75(6):1153-8
pubmed: 22459663
Gastrointest Endosc. 2012 Jan;75(1):165-73
pubmed: 22196814
Gastric Cancer. 2012 Jan;15(1):83-90
pubmed: 21761134
CA Cancer J Clin. 2016 Mar-Apr;66(2):115-32
pubmed: 26808342
Endoscopy. 2014 Sep;46(9):758-61
pubmed: 24830398
Gastrointest Endosc. 2016 Feb;83(2):337-46
pubmed: 26320698
Surg Endosc. 2015 Dec;29(12):3588-93
pubmed: 25894443
Gastrointest Endosc. 2018 May;87(5):1231-1240
pubmed: 29233673
Endoscopy. 2013;45(5):329-34
pubmed: 23468195
Surg Endosc. 2011 Sep;25(9):2926-31
pubmed: 21424195
Gastrointest Endosc. 2018 Feb;87(2):540-548.e1
pubmed: 28987548
J Laparoendosc Adv Surg Tech A. 2018 Oct;28(10):1261-1265
pubmed: 29873625
J Dig Dis. 2015 Nov;16(11):642-8
pubmed: 26431118
Ann Surg. 2017 Feb;265(2):363-369
pubmed: 28059965