{"title":"内镜下胃粘膜下肿瘤全层切除术的技术分析研究（附视频）","authors":"Hitoshi Mori, Noriya Uedo, Satoki Shichijo, Muneshin Morita, Yushi Kawakami, Yasuhiro Tani, Hiroyoshi Iwagami, Muneaki Miyake, Taro Iwatsubo, Minoru Kato, Shunsuke Yoshii, Takashi Kanesaka, Koji Higashino, Tomoki Michida, Ryu Ishihara, Naoki Shinno, Hisashi Hara, Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Omori, Hitoshi Yoshiji","doi":"10.1002/deo2.70198","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Endoscopic full-thickness resection (EFTR) is an effective treatment method for gastric submucosal tumors (SMTs). We aimed to perform a technical analysis of EFTR in gastric SMT and compare it with the outcome parameters.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>Sixty-one gastric SMTs from 60 patients were resected using EFTR. The indication criteria: size, 11–30 mm, connection to the muscularis propria on endoscopic ultrasonography, intraluminal growth type, no ulceration, and histologically evident or clinically suspicious gastrointestinal stromal tumors (GISTs). The following technical improvements were introduced during the study Periods 1–3: routine use of clip-line traction (Periods 1–3); use of a plastic bag retriever (Periods 2–3); adaptation of the reopenable clip over-the-line method (ROLM, Period 3); implementation of no-touch EFTR (Period 3); and elimination of submucosal injection (Period 3).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The endoscopic complete resection rate was 100%, with a similar tumor resection time (median, 50 min) throughout the periods. Specimen damage was less frequent after using the plastic bag retriever in Periods 2 and 3 (<i>p =</i> 0.001). In Period 3, ROLM required longer full-thickness defect closure time (39 min, <i>p =</i> 0.011), but it provided secure closure and shortened the fasting days (<i>p =</i> 0.010). Histological diagnoses included 38 GISTs, 14 leiomyomas, and nine other pathologies. In Period 3, the implementation of no-touch EFTR increased the resected specimen size (33 mm, <i>p</i> = 0.010) and improved the histological complete (R0) resection rate of the GISTs (13/13, 100%, <i>p =</i> 0.017).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Several technical improvements significantly improved the outcomes of EFTR for gastric SMTs, warranting the external validation of this technique.</p>\n </section>\n </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70198","citationCount":"0","resultStr":"{\"title\":\"Endoscopic Full-thickness Resection for Gastric Submucosal Tumor: A Technical Analysis Study (With Video)\",\"authors\":\"Hitoshi Mori, Noriya Uedo, Satoki Shichijo, Muneshin Morita, Yushi Kawakami, Yasuhiro Tani, Hiroyoshi Iwagami, Muneaki Miyake, Taro Iwatsubo, Minoru Kato, Shunsuke Yoshii, Takashi Kanesaka, Koji Higashino, Tomoki Michida, Ryu Ishihara, Naoki Shinno, Hisashi Hara, Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Omori, Hitoshi Yoshiji\",\"doi\":\"10.1002/deo2.70198\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Endoscopic full-thickness resection (EFTR) is an effective treatment method for gastric submucosal tumors (SMTs). We aimed to perform a technical analysis of EFTR in gastric SMT and compare it with the outcome parameters.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Method</h3>\\n \\n <p>Sixty-one gastric SMTs from 60 patients were resected using EFTR. The indication criteria: size, 11–30 mm, connection to the muscularis propria on endoscopic ultrasonography, intraluminal growth type, no ulceration, and histologically evident or clinically suspicious gastrointestinal stromal tumors (GISTs). The following technical improvements were introduced during the study Periods 1–3: routine use of clip-line traction (Periods 1–3); use of a plastic bag retriever (Periods 2–3); adaptation of the reopenable clip over-the-line method (ROLM, Period 3); implementation of no-touch EFTR (Period 3); and elimination of submucosal injection (Period 3).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The endoscopic complete resection rate was 100%, with a similar tumor resection time (median, 50 min) throughout the periods. Specimen damage was less frequent after using the plastic bag retriever in Periods 2 and 3 (<i>p =</i> 0.001). In Period 3, ROLM required longer full-thickness defect closure time (39 min, <i>p =</i> 0.011), but it provided secure closure and shortened the fasting days (<i>p =</i> 0.010). Histological diagnoses included 38 GISTs, 14 leiomyomas, and nine other pathologies. In Period 3, the implementation of no-touch EFTR increased the resected specimen size (33 mm, <i>p</i> = 0.010) and improved the histological complete (R0) resection rate of the GISTs (13/13, 100%, <i>p =</i> 0.017).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Several technical improvements significantly improved the outcomes of EFTR for gastric SMTs, warranting the external validation of this technique.</p>\\n </section>\\n </div>\",\"PeriodicalId\":93973,\"journal\":{\"name\":\"DEN open\",\"volume\":\"6 1\",\"pages\":\"\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-09-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70198\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"DEN open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/deo2.70198\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"DEN open","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/deo2.70198","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景内镜下全层切除（EFTR）是治疗胃粘膜下肿瘤的有效方法。我们的目的是对胃SMT的EFTR进行技术分析，并将其与结果参数进行比较。方法采用EFTR法切除60例患者61例胃smt。适应证：大小，11 - 30mm，超声内镜下与固有肌层连接，腔内生长类型，无溃疡，组织学上明显或临床可疑的胃肠道间质瘤（gist）。在研究1-3期引入了以下技术改进：常规使用夹线牵引（1-3期）；使用塑胶袋回收器（第2-3期）；调整可重新打开的夹子在线方法（ROLM, Period 3）；实施非接触式EFTR（第三期）；消除粘膜下注射（第3期）。结果内镜下全切除率为100%，肿瘤切除时间相似（中位50 min）。在第2期和第3期使用塑料袋回收器后，试样损伤频率较低（p = 0.001）。在第三阶段，ROLM需要更长的全层缺陷闭合时间（39 min, p = 0.011），但它提供了安全的闭合并缩短了禁食时间（p = 0.010）。组织学诊断为胃肠道间质瘤38例，平滑肌瘤14例，其他病理9例。在第3期，实施无接触EFTR增加了切除的标本大小（33 mm, p = 0.010），提高了gist的组织学完全切除率（R0） （13/13, 100%, p = 0.017）。结论几项技术改进显著提高了EFTR对胃smt的疗效，值得对该技术进行外部验证。
Endoscopic Full-thickness Resection for Gastric Submucosal Tumor: A Technical Analysis Study (With Video)
Background
Endoscopic full-thickness resection (EFTR) is an effective treatment method for gastric submucosal tumors (SMTs). We aimed to perform a technical analysis of EFTR in gastric SMT and compare it with the outcome parameters.
Method
Sixty-one gastric SMTs from 60 patients were resected using EFTR. The indication criteria: size, 11–30 mm, connection to the muscularis propria on endoscopic ultrasonography, intraluminal growth type, no ulceration, and histologically evident or clinically suspicious gastrointestinal stromal tumors (GISTs). The following technical improvements were introduced during the study Periods 1–3: routine use of clip-line traction (Periods 1–3); use of a plastic bag retriever (Periods 2–3); adaptation of the reopenable clip over-the-line method (ROLM, Period 3); implementation of no-touch EFTR (Period 3); and elimination of submucosal injection (Period 3).
Results
The endoscopic complete resection rate was 100%, with a similar tumor resection time (median, 50 min) throughout the periods. Specimen damage was less frequent after using the plastic bag retriever in Periods 2 and 3 (p = 0.001). In Period 3, ROLM required longer full-thickness defect closure time (39 min, p = 0.011), but it provided secure closure and shortened the fasting days (p = 0.010). Histological diagnoses included 38 GISTs, 14 leiomyomas, and nine other pathologies. In Period 3, the implementation of no-touch EFTR increased the resected specimen size (33 mm, p = 0.010) and improved the histological complete (R0) resection rate of the GISTs (13/13, 100%, p = 0.017).
Conclusion
Several technical improvements significantly improved the outcomes of EFTR for gastric SMTs, warranting the external validation of this technique.
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