Endoscopic Full-thickness Resection In Treatment Of Gastric Submucosal Tumors Originating From Muscularis Propria

BackgroundEndoscopic resection of gastric submucosal tumors(SMT)has developed rapidly in recent decades.Gastric submucosal tumors less than 2cm are always asymptomatic,which are discovered by endoscopy or radiological investigations incidentally due to other reasons.However,the gastric submucosal tumors with higher lesion and higher malignant degree may cause bleeding,abdominal pain,abdominal distension,abdominal mass and weight loss.Gastric submucosal tumors are mainly divided into four categories-gastric stromal tumors with malignant potential,smooth muscle derived as leiomyoma and leiomyosarcoma,neurogenic tumors as schwannoma and neurofibroma and vascular tumors as hemangioma and lymphangioma.Gastrointestinal stromal tumors(GIST)are potentially malignant tumors derived from stromal cells of the gastrointestinal tract.It is originated from the interstitial Cajal cells,and is driven by the mutated c-kit gene or platelet-derived growth factor receptor alpha(PDGFRA)gene.Gastric stromal tumors are consisted histologically of spindle cells and epithelioid cells,occasionally of pleomorphic cells,arranging in fascicles or diffuse,whose immunohistochemical detection are usually expressed as CD117 or DOG-1 positive.Based on the potential of recurrence and metastasis,Gastric stromal tumors can be divided into very low risk,low risk,intermediate risk and high risk.Surgical resection of gastric submucosal tumors mainly includes open surgery and laparoscopic surgery with long operation time,long hospital stay and high complication rate,which will affect quality of life significantly,and which may increase the risk of remain gastric cancer.Minimally invasive endoscopic techniques have many advantages,such as small trauma,quick recovery and low cost.It has been widely used in clinic in recent years.With the deepening of the concept of minimally invasive operation,the maturity and development of endoscopic technology,medical technology and endoscopic equipment,endoscopic full-thickness resection(EFTR)came into being based on the development of endoscopic submucosal dissection(ESD).EFTR is an effective treatment for the removal of SMT originating from muscularis propria,which has become one of the treatment options for SMT originating from the muscularis propria.ObjectiveThis study aimed to evaluate the efficacy,feasibility and safety of EFTR in the treatment of gastric submucosal tumors originating from the muscularis propria.MethodsRetrospectively analyze clinical data of 24 patients who accepted EFTR from December,2014 to December,2016 in gastroenterology department of Qilu Hospital of Shandong University.All patients were performed SMTs originating from the muscularis propria with no metastasis by ultrasonography(EUS)before the operation.Procedures:① Determine the location of the tumor,mark the edge of the lesion,inject into submucosa,pre-incision the tumor along the mucosa and submucosa,expose the tumor;② separate muscularis propria along the periphery of the tumor;③incision the serosal layer along the tumor,cause artificial perforation;④resect the tumor completely;⑤close the wound from one side to another side.ResultsEFTR was successfully performed in all 24 cases,in which males were 9,female were 15.The complete resection rate was 100%.The mean age of the patients was 59.75±10.83years.There were 15 tumors located in the fundus of stomach,7 in corpus,and 2 in antrum.The mean tumor size was 1.56±0.86cm.The mean operation time was 95.83±44.37min.The mean hospitalization time was 10.21 ±2.50d.The mean hospitalization cost was 33719.97 yuan.Pathological diagnoses of the tumors were gastrointestinal stromal tumors(18/24),leiomyoma(3/24),Schwannoma(2/24)and plexiform fibromyxoma(1/24).No patients developed massive bleeding,delayed bleeding,peritonitis or abdominal abscess after the procedure.The follow-up period after the procedure was from 3 to 23 months,and no tumor recurrence or tumor metastasis was detected during the follow-up period.ConclusionsEndoscopic full-thickness resection(EFTR)is a safe,effective and minimally invasive method for the treatment of gastric submucosal tumors originating from muscularis propria,with outstanding clinical value.