Subscribe to RSS
Traction-assisted endoscopic full-thickness resection followed by O-ring and over-the-scope clip closure in the stomach: an animal experimental study
Background and study aims Exposed endoscopic full-thickness resection (EFTR) enables the operator to obtain a sufficient surgical margin. However, insufflation leakage and secure endoscopic full-thickness closure (EFTC) remain problematic. This study aimed to evaluate the safety and feasibility of a new exposed EFTR.
Patients and methods Exposed EFTR was performed for 2-cm virtual lesions in different locations of the upper stomach in four dogs. EFTR mainly involved half-circumferential EFTR of the endpoint and clip-line traction. Pulley traction was applied with the forward approach for the greater curvature. EFTC involved endoscopic ligation with O-ring closure to diminish insufflation leakage, followed by over-the-scope clip closure.
Results Complete resection and technical success were achieved in all four cases. One case of intraoperative bleeding was endoscopically managed. No postoperative complications occurred in any cases. The median maximum resected size was 27.5 mm. The median procedure time of the total operation, EFTR, and EFTC was 76, 37, and 35.5 minutes, respectively. The 1-month survival rate was 100 %.
Conclusions This therapeutic strategy may lead to the establishment of exposed EFTR.
Received: 31 July 2020
Accepted: 02 October 2020
Article published online:
01 January 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Zhou PH, Yao LQ, Qin XY. et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 2011; 25: 2926-2931
- 2 Matsuda T, Nunobe S, Kosuga T. et al. Society for the Study of Laparoscopy and Endoscopy Cooperative Surgery. Laparoscopic and luminal endoscopic cooperative surgery can be a standard treatment for submucosal tumors of the stomach: a retrospective multicenter study. Endoscopy 2017; 49: 476-483
- 3 Xu MD, Cai MY, Zhou PH. et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 2012; 75: 195-199
- 4 Guo J, Liu Z, Sun S. et al. Endoscopic full-thickness resection with defect closure using an over-the-scope clip for gastric subepithelial tumors originating from the muscularis propria. Surg Endosc 2015; 29: 3356-3362
- 5 Dobashi A, Rajan E, Knipschield MA. et al. Endoscopic full-thickness resection using suture loop needle T-tag tissue anchors in the porcine stomach (with video). Gastrointest Endosc 2018; 87: 590-596
- 6 Goto O, Sasaki M, Akimoto T. et al. Feasibility and safety of third-space endoscopic full-thickness resection in ex vivo and in vivo porcine models. Endosc Int Open 2019; 7: E471-E476
- 7 Mori H, Kobara H, Kazi R. et al. Balloon-armed mechanical counter traction and double-armed bar suturing systems for pure endoscopic full-thickness resection. Gastroenterology 2014; 147: 278-280
- 8 Huberty V, Leclercq L, Hiernaux M. et al. Endoscopic full-thickness resection using an endoluminal-suturing device: a proof-of-concept study. Endosc Int Open 2019; 7: E1310-E1315
- 9 Jeon WJ, You IY, Chae HB. et al. A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection. Gastrointest Endosc 2009; 69: 29-33
- 10 Li CH, Chen PJ, Chu HC. et al. Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). Gastrointest Endosc 2011; 73: 163-167
- 11 Nishiyama N, Kobara H, Kobayashi N. et al. Novel endoscopic ligation with O-ring closure involving muscle layer of a gastric artificial defect. Endoscopy 2020; DOI: 10.1055/a-1149-8597.
- 12 Li B, Shi Q, Qi ZP. et al. 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. Surg Endosc 2019; 33: 3864-3873
- 13 Kobara H, Mori H, Nishiyama N. et al. Over-the-scope clip system: A review of 1517 cases over 9 years. J Gastroenterol Hepatol 2019; 34: 22-30
- 14 Fähndrich M, Sandmann M. Endoscopic full-thickness resection for gastrointestinal lesions using the over-the-scope clip system: a case series. Endoscopy 2015; 47: 76-79
- 15 Kobayashi M, Sumiyama K, Ban Y. et al. Closure of iatrogenic large mucosal and full-thickness defects of the stomach with endoscopic interrupted sutures in in vivo porcine models: are they durable enough?. BMC Gastroenterol 2015; 15: 5
- 16 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicenter study in various indications. Gut 2018; 67: 1280-1289