1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
3Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
© 2024 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest
Supplementary Video 1 included in this paper is a partially modified version of a case that was presented at the DDW’s video forum in 2017. Ji Yong Ahn is currently serving as a section editor for Clinical Endoscopy; however, he was not involved in the peer reviewer selection, evaluation, or decision process of this article. The other authors have no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: YK, JYA, HYJ; Data curation: all authors; Formal analysis: YK, JYA; Supervision: HYJ; Writing–original draft: YK, JYA; Writing–review & editing: all authors.
Characteristic | Total (n=83) | ESD (n=51) | cc-EFTR (n=32) | p-value |
---|---|---|---|---|
Hospital stays (day) | 5.0 (4.0–6.0) | 5.0 (4.0–6.0) | 5.0 (4.0–6.0) | 0.926 |
Pathologic size (mm) | 20.0 (15.0–24.0) | 21.0 (16.0–25.0) | 19.0 (15.0–22.0) | 0.076 |
Mitosis, per 50 HPF | 0.676 | |||
≤5 | 65 (78.3) | 41 (80.4) | 24 (75.0) | |
6–10 | 15 (18.1) | 7 (13.7) | 8 (25.0) | |
>10 | 3 (3.6) | 3 (5.9) | 0 (0) | |
Tumor gradea) | 0.172 | |||
Very low risk | 36 (43.4) | 18 (35.3 | 18 (56.3) | |
Low risk | 30 (36.1) | 23 (45.1) | 7 (21.9) | |
Intermediate risk | 14 (16.9) | 7 (13.7) | 7 (21.9) | |
High risk | 3 (3.6) | 3 (5.9) | 0 (0) | |
Resection margin | 0.002 | |||
R0 | 53 (63.9) | 26 (51.0) | 27 (84.4) | |
R1 | 23 (27.7) | 19 (37.3) | 4 (12.5) | |
R2 | 7 (8.4) | 6 (11.8) | 1 (3.1) | |
Procedure time (min) | 33.0 (21.0–51.0) | 28.0 (20.0–46.0) | 39.5 (30.5–54.8) | 0.026 |
Values are presented as median (interquartile range) or number (%).
ER, endoscopic resection; ESD, endoscopic submucosal dissection; cc-EFTR, clip-and-cut endoscopic full-thickness resection; HPF, high-power field.
a)Tumor grade was based on modified National Institute of Health consensus criteria, 2008.
Characteristic | Total (n=83) | ESD (n=51) | cc-EFTR (n=32) | p-value |
---|---|---|---|---|
Fever | 20 (24.1) | 7 (13.7) | 13 (40.6) | 0.006 |
Pneumoperitoneum | 35 (42.2) | 13 (25.5) | 22 (68.8) | <0.001 |
Peritonitis | 3 (3.6) | 1 (2.0) | 2 (6.3) | 0.311 |
Characteristic | Total (n=83) | ESD (n=51) | cc-EFTR (n=32) | p-value |
---|---|---|---|---|
Sex | 0.559 | |||
Male | 33 (39.8) | 19 (37.3) | 14 (43.8) | |
Female | 50 (60.2) | 32 (62.7) | 18 (56.3) | |
Age (yr) | 59.0 (51.0–68.0) | 58.0 (51.0–66.0) | 64.0 (53.3–69.8) | 0.142 |
Follow-up period (month) | 25.0 (13.0–49.0) | 29.0 (13.0–85.0) | 24.5 (12.3–37.8) | 0.211 |
Location | <0.001 | |||
Upper third | 56 (67.5) | 27 (52.9) | 29 (90.6) | |
Middle third | 16 (19.3) | 14 (27.5) | 2 (6.3) | |
Lower third | 11 (13.3) | 10 (19.6 | 1 (3.1) | |
Initial EUS size (mm) | 15.8 (11.3–19.4) | 15.7 (12.0–20.0) | 16.0 (10.0–19.2) | 0.597 |
Final EUS size (mm) | 19.0 (14.8–22.3) | 20.0 (15.0–23.0) | 17.9 (13.0–20.6) | 0.108 |
Indication of ER | 0.480 | |||
Highly suspicious of GIST | 28 (33.7) | 16 (31.4) | 12 (37.5) | |
Change of size or shape | 45 (54.2) | 28 (54.9) | 17 (53.1) | |
Refusal of surgery | 10 (12.0) | 7 (13.7) | 3 (9.4) | |
Echogenicity | 0.851 | |||
Hypoechoic | 80 (96.4) | 49 (96.1) | 31 (96.9) | |
Mixed echoic | 3 (3.6) | 2 (3.9) | 1 (3.1) | |
Homogeneity | 0.480 | |||
Homogeneous | 64 (77.1) | 38 (74.5) | 26 (81.3) | |
Inhomogeneous | 19 (22.9) | 13 (25.5) | 6 (18.8) | |
Hyperechoic foci | 0.899 | |||
None | 68 (81.9) | 42 (82.4) | 26 (81.3) | |
Yes | 15 (18.1) | 9 (17.6) | 6 (18.8) | |
Cystic foci | 0.027 | |||
None | 75 (90.4) | 49 (96.1) | 26 (81.3) | |
Yes | 8 (9.6) | 2 (3.9) | 6 (18.8) | |
MP involvement | <0.001 | |||
None | 1 (1.2) | 1 (2.0) | 0 (0) | |
<50% | 28 (33.7) | 27 (52.9) | 1 (3.1) | |
≥50% | 19 (22.9) | 11 (21.6) | 8 (25.0) | |
Outside of MP | 35 (42.2) | 12 (23.5) | 23 (71.9) | |
Gross morphology | 0.035 | |||
Pedunculated | 38 (45.8) | 27 (52.9) | 11 (34.4) | |
Semi-pedunculated | 31 (37.3) | 19 (37.3) | 12 (37.5) | |
Sessile | 14 (16.9) | 5 (9.8) | 9 (28.1) |
Characteristic | Total (n=83) | ESD (n=51) | cc-EFTR (n=32) | p-value |
---|---|---|---|---|
Hospital stays (day) | 5.0 (4.0–6.0) | 5.0 (4.0–6.0) | 5.0 (4.0–6.0) | 0.926 |
Pathologic size (mm) | 20.0 (15.0–24.0) | 21.0 (16.0–25.0) | 19.0 (15.0–22.0) | 0.076 |
Mitosis, per 50 HPF | 0.676 | |||
≤5 | 65 (78.3) | 41 (80.4) | 24 (75.0) | |
6–10 | 15 (18.1) | 7 (13.7) | 8 (25.0) | |
>10 | 3 (3.6) | 3 (5.9) | 0 (0) | |
Tumor grade |
0.172 | |||
Very low risk | 36 (43.4) | 18 (35.3 | 18 (56.3) | |
Low risk | 30 (36.1) | 23 (45.1) | 7 (21.9) | |
Intermediate risk | 14 (16.9) | 7 (13.7) | 7 (21.9) | |
High risk | 3 (3.6) | 3 (5.9) | 0 (0) | |
Resection margin | 0.002 | |||
R0 | 53 (63.9) | 26 (51.0) | 27 (84.4) | |
R1 | 23 (27.7) | 19 (37.3) | 4 (12.5) | |
R2 | 7 (8.4) | 6 (11.8) | 1 (3.1) | |
Procedure time (min) | 33.0 (21.0–51.0) | 28.0 (20.0–46.0) | 39.5 (30.5–54.8) | 0.026 |
Variable | Univariate analysis |
Multivariable analysis |
||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Sex | ||||
Male | 1 | |||
Female | 1.944 (0.780–4.850) | 0.154 | ||
Age | 1.020 (0.978–1.065) | 0.352 | ||
Tumor grade | ||||
Very low to low | 1 | |||
Intermediate to high | 1.463 (0.461–4.648) | 0.518 | ||
Location | ||||
Upper third | 1 | |||
Middle to lower third | 0.747 (0.290–1.924) | 0.546 | ||
Morphology | ||||
Pedunculated | 1 | 1 | ||
Semi-pedunculated | 1.890 (0.705–5.067) | 1.601 (0.556–4.611) | ||
Sessile | 5.400 (1.061–27.472) | 0.094 | 3.438 (0.599–19.719) | 0.334 |
MP involvement | ||||
<50% | 1 | 1 | ||
≥50% | 2.217 (0.871–5.639) | 0.095 | 0.884 (0.285–2.741) | 0.831 |
Pathologic size | ||||
<25 mm | 1 | 1 | ||
≥25 mm | 0.353 (0.126–0.992) | 0.048 | 0.597 (0.196–1.820) | 0.365 |
Procedure method | ||||
ESD | 1 | 1 | ||
cc-EFTR | 5.192 (1.727–15.613) | 0.003 | 5.192 (1.727–15.613) | 0.003 |
Procedure time | 0.989 (0.969–1.009) | 0.272 |
Case no. | Sex/age (y) | Method of ER | Location | Indication for surgery | Method of surgery |
---|---|---|---|---|---|
1 | Male/51 | ESD | Middle third | R2 resection | Staged WR |
2 | Male/49 | ESD | Upper third | R2 resection | Staged TG |
3 | Female/59 | ESD | Middle third | R2 resection | Staged WR |
4 | Female/63 | ESD | Middle third | Bleeding | Emergent WR |
5 | Female/54 | ESD | Upper third | R2 resection | Staged WR |
6 | Male/72 | cc-EFTR | Upper third | Gross perforation | Emergent WR |
7 | Female/53 | ESD | Upper third | R2 resection | Staged WR |
Characteristic | Total (n=83) | ESD (n=51) | cc-EFTR (n=32) | p-value |
---|---|---|---|---|
Fever | 20 (24.1) | 7 (13.7) | 13 (40.6) | 0.006 |
Pneumoperitoneum | 35 (42.2) | 13 (25.5) | 22 (68.8) | <0.001 |
Peritonitis | 3 (3.6) | 1 (2.0) | 2 (6.3) | 0.311 |
Values are presented as number (%) or median (interquartile range). GIST, gastrointestinal stromal tumor; ESD, endoscopic submucosal dissection; cc-EFTR, clip-and-cut endoscopic full-thickness resection; EUS, endoscopic ultrasonography; MP, muscularis propria.
Values are presented as median (interquartile range) or number (%). ER, endoscopic resection; ESD, endoscopic submucosal dissection; cc-EFTR, clip-and-cut endoscopic full-thickness resection; HPF, high-power field. Tumor grade was based on modified National Institute of Health consensus criteria, 2008.
OR, odds ratio; CI, confidence interval; MP, muscularis propria; ESD, endoscopic submucosal dissection; cc-EFTR, clip-and-cut endoscopic full-thickness resection.
ER, endoscopic resection; ESD, endoscopic submucosal dissection; WR, wedge resection; TG, total gastrectomy; cc-EFTR, clip-and-cut endoscopic full-thickness resection.
Values are presented as number (%). ER, endoscopic resection; ESD, endoscopic submucosal dissection; cc-EFTR, clip-and-cut endoscopic full-thickness resection.