Clinical Endoscopy

Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea: Yuri Kim, Ji Yong Ahn, Hwoon-Yong Jung, Seokin Kang, Ho June Song, Kee Don Choi, Do Hoon Kim, Jeong Hoon Lee, Hee Kyong Na, Young Soo Park; Clin Endosc 2024;57(3):350-363. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.144

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Background
/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs.
Methods
Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed.
Results
Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group.
Conclusions
cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.

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Endoscopic resection penetrating the muscularis propria for gastric gastrointestinal stromal tumors: advances and challenges
Jin Woong Cho
Clinical Endoscopy.2024; 57(3): 329. CrossRef

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Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria: Ah Lon Jung, Sang Wook Park, Gun Young Hong, Hyeong Chul Moon, Seo Joon Eun; Clin Endosc 2021;54(1):131-135. Published online August 21, 2020; DOI: https://doi.org/10.5946/ce.2020.070

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Most cases of gastric subepithelial lesions follow a good clinical course; however, some lesions progress to malignant tumors, and treatment of tumors with a high risk of malignancy is essential. Surgical excision has been the primary treatment for tumors originating from the propria muscle layer, but it has the disadvantages of being invasive and causing postoperative functional abnormalities. With the development of endoscopic techniques and instruments, the role of endoscopic resection, which is a less invasive method for the removal of gastric subepithelial lesions, has been attracting attention. We performed an endoscopic full-thickness resection for 8 patients with gastric subepithelial lesions originating from the muscularis propria. No fatal complications occurred. Our findings suggest the need to develop various devices for resection and closure and to accumulate further experience through additional studies to prevent complications and specimen loss.

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Robotic Platforms for Therapeutic Flexible Endoscopy: A Literature Review
Naoya Tada, Kazuki Sumiyama
Diagnostics.2024; 14(6): 595. CrossRef
Advances of endoscopic and surgical management in gastrointestinal stromal tumors
Lei Yue, Yingchao Sun, Xinjie Wang, Weiling Hu
Frontiers in Surgery.2023;[Epub] CrossRef
Current Status of Endoscopic Full-Thickness Resection for Gastric Subepithelial Tumors: A Literature Review Over Two Decades
Naoya Tada, Hideki Kobara, Noriko Nishiyama, Shintaro Fujihara, Tsutomu Masaki, Noriya Uedo
Digestion.2023; 104(6): 415. CrossRef
Endoscopic Full Thickness Resection: A Systematic Review
Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
Journal of Digestive Endoscopy.2022; 13(03): 152. CrossRef

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Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract: Cicilia Marcella, Shakeel Sarwar, Hui Ye, Rui Hua Shi; Clin Endosc 2020;53(4):458-465. Published online March 17, 2020; DOI: https://doi.org/10.5946/ce.2019.121

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Background
/Aims: Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinal stromal tumors (GISTs). However, the efficacy of ET remains debatable. In this study, we evaluated the efficacy and safety of ET for GISTs in the upper gastrointestinal tract.
Methods
This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 to July 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, and follow-up were investigated and analyzed.
Results
Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the fundus with a mean tumor size of 2.1±1.43 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.29 years, 64.7±35.23 minutes, 6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and 3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence or metastasis.
Conclusions
ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment of choice for patients with no metastasis.

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Comparison of endoscopic full-thickness resection and cap-assisted endoscopic full-thickness resection in the treatment of small (≤1.5 cm) gastric GI stromal tumors
Jinping Yang, Muhan Ni, Jingwei Jiang, Ximei Ren, Tingting Zhu, Shouli Cao, Shahzeb Hassan, Ying Lv, Xiaoqi Zhang, Yongyue Wei, Lei Wang, Guifang Xu
Gastrointestinal Endoscopy.2022; 95(4): 660. CrossRef
The necessarity of treatment for small gastric subepithelial tumors (1–2 cm) originating from muscularis propria: an analysis of 972 tumors
Jinlong Hu, Xinzhu Sun, Nan Ge, Sheng Wang, Jintao Guo, Xiang Liu, Guoxin Wang, Siyu Sun
BMC Gastroenterology.2022;[Epub] CrossRef
Natural History of Asymptomatic Esophageal Subepithelial Tumors of 30 mm or Less in Size
Seokin Kang, Do Hoon Kim, Yuri Kim, Dongsub Jeon, Hee Kyong Na, Jeong Hoon Lee, Ji Yong Ahn, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
Massive Digestive Hemorrhagia Revealing a Gastro-Intestinal Stromal Tumor of the Jejunum
Yasmine Cherouaqi, Fatima zahra Belabbes, Hanane Delsa, Anass Nadi, Fedoua Rouibaa
Cureus.2021;[Epub] CrossRef
Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract
In Kyung Yoo, Joo Young Cho
Clinical Endoscopy.2020; 53(4): 383. CrossRef
Recent advances in the management of gastrointestinal stromal tumor
Monjur Ahmed
World Journal of Clinical Cases.2020; 8(15): 3142. CrossRef

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Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal Tumors: Faisal Inayat, Aysha Aslam, Mathew D. Grunwald, Qulsoom Hussain, Abu Hurairah, Shahzad Iqbal; Clin Endosc 2019;52(3):283-287. Published online October 5, 2018; DOI: https://doi.org/10.5946/ce.2018.116

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arising from the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasingly detected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advanced technique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a number of methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem is appropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge, this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic option in patients with gastric GISTs.

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Endoscopic Full Thickness Resection: A Systematic Review
Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
Journal of Digestive Endoscopy.2022; 13(03): 152. CrossRef
Colon Sparing Endoscopic Full-Thickness Resection for Advanced Colorectal Lesions: Is It Time for Global Adoption?
Zhong-Wei Wu, Chao-Hui Ding, Yao-Dong Song, Zong-Chao Cui, Xiu-Qian Bi, Bo Cheng
Frontiers in Oncology.2022;[Epub] CrossRef
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Adnan Malik, Rizwan Ishtiaq, Muhammad Hassan Naeem Goraya, Faisal Inayat, Vinaya V. Gaduputi
Journal of Investigative Medicine High Impact Case Reports.2021; 9: 232470962110132. CrossRef
Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era
Antonino Granata, Alberto Martino, Dario Ligresti, Francesco Paolo Zito, Michele Amata, Giovanni Lombardi, Mario Traina
World Journal of Gastrointestinal Surgery.2021; 13(7): 645. CrossRef
Use of omental patch and endoscopic closure technique as an alternative to surgery after endoscopic full thickness resection of gastric intestinal stromal tumors: A series of cases
Amit H Sachdev, Shahzad Iqbal, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura
World Journal of Clinical Cases.2020; 8(1): 120. CrossRef
Endoscopic full-thickness resection
David Friedel, Xiaocen Zhang, Rani Modayil, Stavros N. Stavropoulos
Techniques in Gastrointestinal Endoscopy.2019; 21(1): 19. CrossRef

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Endoscopic Full-Thickness Resection Combined with Laparoscopic Surgery: Chan Gyoo Kim; Clin Endosc 2018;51(1):33-36. Published online January 12, 2018; DOI: https://doi.org/10.5946/ce.2017.153

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Endoscopic full-thickness resection combined with laparoscopic surgery was recently developed. These procedures could be categorized as “Cut first and then suture” and “Suture first and then cut”. “Cut first and then suture” includes laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR). Recent studies have demonstrated the safety and efficacy of LECS and LAEFR. However, these techniques are limited by the related exposure of the tumor and gastric mucosa to the peritoneal cavity and manipulation of these organs, which could lead to viable cancer cell seeding and the spillage of gastric juice into the peritoneal cavity. In the “Suture first and then cut” technique, the serosal side of the stomach is sutured to invert the stomach and subsequently endoscopic resection is performed. In this article, details of these techniques, including their advantages and limitations, are described.

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Noriaki Kashu, Noriyuki Nishiwaki, Tetsuya Kagawa, Tomokazu Kakishita, Shinji Hato
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Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
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Choice of LECS Procedure for Benign and Malignant Gastric Tumors
Jae-Seok Min, Kyung Won Seo, Sang-Ho Jeong
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Yuki Aisu, Daiki Yasukawa, Yusuke Kimura, Tomohide Hori
World Journal of Gastrointestinal Oncology.2018; 10(11): 381. CrossRef

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Current Techniques for Treating Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract: Weon Jin Ko, Joo Young Cho; Clin Endosc 2016;49(3):226-228. Published online May 23, 2016; DOI: https://doi.org/10.5946/ce.2016.061

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Most gastrointestinal stromal tumors (GISTs) arise from the proper muscle layer of the upper gastrointestinal (GI) tract and have a low malignant potential. They are sometimes accompanied by symptoms, but in most cases are detected by chance. Endoscopic surgery of subepithelial tumors in the upper GI tract has been actively performed, and its merits include the need for fewer medical devices compared with other surgical procedures and post-resection organ preservation. However, because endoscopic procedures are still limited to small or pilot studies, a multidisciplinary approach combining laparoscopy and endoscopy is needed for more effective and pathologically acceptable management of GISTs. Many new endoscopic surgeries have been developed, and this review describes the current status of and the new approaches for endoscopic surgery of GISTs in the upper GI tract.

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Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea
Yuri Kim, Ji Yong Ahn, Hwoon-Yong Jung, Seokin Kang, Ho June Song, Kee Don Choi, Do Hoon Kim, Jeong Hoon Lee, Hee Kyong Na, Young Soo Park
Clinical Endoscopy.2024; 57(3): 350. CrossRef
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I. O. Krylov, I. I. Nikulin
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Advances in endoscopic resection techniques of small gastric tumors originating from the muscularis propria
Suliman Khan, Xiaona Cui, Safyan Nasir, Shoaib Mohammad Rafiq, Bo Qin, Qian Bai
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New data on the composition of plagioclase on the western flank of the Oktyabrsky deposit according to infrared spectroscopy
I. O. Krylov, I. I. Nikulin, A. A. Samsonov, D. M. Korshunov, D. I. Vildanov
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A modified endoscopic full thickness resection for gastric subepithelial tumors from muscularis propria layer: Novel method
Jung Min Lee, In Kyung Yoo, Sung Pyo Hong, Joo Young Cho, Young Kwan Cho
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Endoskopische Vollwandresektion im oberen Gastrointestinaltrakt – erste Erfahrungen
T. Heuer, C. D. Gerharz, M. Banysch, G. M. Kaiser, M. Hornstein, E. Kasim
Der Gastroenterologe.2020; 15(5): 403. CrossRef
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Ming‐Yan Cai, Francisco Martin Carreras‐Presas, Ping‐Hong Zhou
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Shiyi Song, Wei Ren, Yi Wang, Shu Zhang, Song Zhang, Fei Liu, Qiang Cai, Guifang Xu, Xiaoping Zou, Lei Wang
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A Case of Endoscopic Full-Thickness Resection in a Patient with Gastric High-Grade Dysplasia Unsuitable for Endoscopic Submucosal Dissection: Jung Min Chae, Jae Young Jang, Seonghun Hong, Jung Wook Kim, Young Woon Chang; Clin Endosc 2014;47(4):353-357. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.353

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Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8×0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.

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Edward Young, Hamish Philpott, Rajvinder Singh
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Jeffrey Fiorenza, Pavlos Kaimakliotis
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