A novel and simplified closure method for defect closure after endoscopic full-thickness resection of gastric submucosal tumors: short-term outcomes of

Jie HE; Baisheng CHEN; Pinghong ZHOU; Yunshi ZHONG; Weifeng CHEN; Yiqun ZHANG; Quanlin LI; Jianwei HU

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A novel and simplified closure method for defect closure after endoscopic full-thickness resection of gastric submucosal tumors: short-term outcomes of "Shao-Mai" closure method

VernacularTitle: "烧卖缝合法"在胃黏膜下肿瘤内镜全层切除术后应用的近期疗效分析
Author: Jie HE ¹ ; Baisheng CHEN ¹ ; Pinghong ZHOU ² ; Yunshi ZHONG ² ; Weifeng CHEN ² ; Yiqun ZHANG ² ; Quanlin LI ² ; Jianwei HU ²
Author Information

1. Endoscopy Center of Xiamen Hospital of Zhongshan Hospital, Fudan University, Xiamen 361015, China
2. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy, Shanghai 200032, China
Publication Type:Journal Article
Keywords: Gastric submucosal tumors; Endoscopic full-thickness resection; Gastric perforation; Endoscopic closure technique
From: Chinese Journal of Gastrointestinal Surgery 2020;23(2):183-187
CountryChina
Language:Chinese
Abstract: Objective:To evaluate the feasibility and short-term efficacy of a novel and simplified closure method developed by our team for the defect closure after endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMT) in the gastric wall.
Methods:A prospective single-arm clinical study was used. Inclusion criteria: (1) the lesion was located in the fundus or the greater curvature of the stomach, and was confirmed to originate from the muscularis propria layer; (2) the diameter of the tumor was ≤3.5 cm, and the tumor had no extensive adhesion to the peritoneal tissues and organs in extraperitoneal cavity; (3) the tumor had no malignant features under ultrasound endoscopy; (4) the patient agreed to participate in the study; (5) patients with severe complications were excluded. Based on the above criteria, 20 patients with gastric SMT at the Endoscopy Center of Zhongshan Hospital of Fudan University from January 2015 to March 2018 were enrolled in this study, including 5 males and 15 females with mean age of 61.1 (38 to 70) years. Grasping forceps-assisted endo-loop snare ligation device which is called "Shao-Mai" method was used to close the defect site. All the patients underwent EFTR and "Shao-Mai" method to perform defect closure. After successful tumor resection by EFTR, an endo-loop was anchored onto the edge of the gastric defect with grasping forceps assistance and closed tightly. The observation indicators included tumor size, en bloc resection, operation time, postoperative complications and hospital stay. The follow-up indicators included tumor residual, local recurrence, and metachronous lesions.
Results:All the 20 lesions were located in the muscularis propria with a size of 0.5-3.5 (mean 1.4) cm. Three of them were located in the greater curvature of the mid-upper gastric body, 17 were located in the fundus. The endoscopic "Shao-Mai" closure was successfully performed after EFTR in all the 20 cases. Endoscope was used uniquely through the entire process, without laparoscopic assistance. The operative time was 20-100 (mean 43.8) minutes, while the "Shao-Mai" closure procedure took a range of 3-30 (mean 10.1) minutes. The en bloc resection rate was 100%. The pathological diagnosis included 17 gastrointestinal stromal tumors and 3 leiomyomas. No major complications occurred during or after surgery. All the patients were discharged 1-11 (mean 3.1) days after operation. The wounds of all the cases were healed completely six months after operation and only scar was observed without ulcer. No residual lesion, tumor recurrence or metastasis, leakage or fistula of digestive tract were found during the follow-up period of 15-54 (median 41) months.
Conclusion:The endoscopic "Shao-Mai" closure method is a simplified novel way, which is feasible, effective, and safe for closing the gastric defect after EFTR.