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      Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era

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          Abstract

          Exposed endoscopic full-thickness resection (EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors. To date, various techniques have been used for the closure of the transmural post-EFTR defect, mainly consisting in clip- and endoloop-assisted closure methods. However, the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure. The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance, also considering the recent advent of flexible endoscopic suturing.

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          Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria.

          Ping Zhou, Zheng Liu, Xin-Yue Qin … (2011)
          This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria. Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips. EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60-145) min. The mean resected lesion size was 2.8 (range, 1.2-4.5) cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8 months; range, 6-24 months). EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.
          Article 0 comments Cited 75 times – based on 0 reviews     Review now
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            ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection

            Harry Aslanian, Amrita Sethi, Manoop S. Bhutani … (2019)
            With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as “exposed” and “nonexposed.” In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.
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              Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video).

              Shinya Minami, Ichiro Oda, Hiroyuki Ono … (2006)
              When gastric perforation occurs during endoscopic resection for early gastric cancer, a surgical treatment generally is performed. Considering the increasing number of EMRs and the possibility of perforation, our research sought to investigate whether endoscopic treatment for gastric perforation is possible. From 1987 to 2004, 121 of 2460 patients who underwent gastric EMR at the National Cancer Center Hospital had gastric perforation during EMR (4.9%). The initial 4 patients were treated with emergent surgery. The subsequent 117 patients who were treated with endoclips formed our study population. Endoscopic closure with endoclips in 115 patients (98.3%) was successful. Two patients with unsuccessful endoscopic closure underwent emergent surgery. In the past 6 years, patients with perforation during gastric EMR treated with endoscopic closure had a recovery rate similar to that of the nonperforation cases. Gastric perforation during endoscopic resection can be conservatively treated by complete endoscopic closure with endoclips.
              Article 0 comments Cited 48 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Antonino Granata
                Alberto Martino
                Dario Ligresti
                Francesco Paolo Zito
                Michele Amata
                Giovanni Lombardi
                Mario Traina
                Journal
                Journal ID (nlm-ta): World J Gastrointest Surg
                Journal ID (publisher-id): WJGS
                Title: World Journal of Gastrointestinal Surgery
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 1948-9366
                Publication date (Print): 27 July 2021
                Publication date (Electronic): 27 July 2021
                Volume: 13
                Issue: 7
                Pages: 645-654
                Affiliations
                Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
                Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy. alberto-martino@ 123456libero.it
                Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
                Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
                Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
                Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
                Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
                Author notes

                Author contributions: Granata A, Martino A and Ligresti D designed research and wrote, edited and finalized the text; Martino A, Zito FP and Amata M performed literature search and analyzed the data; Lombardi G and Traina M reviewed the paper for important intellectual content.

                Corresponding author: Alberto Martino, MD, Staff Physician, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Via Antonio Cardarelli 9, Napoli 80131, Italy. alberto-martino@ 123456libero.it

                Article
                Other ID: jWJGS.v13.i7.pg645
                DOI: 10.4240/wjgs.v13.i7.645
                PMC ID: 8316845
                PubMed ID: 34354798
                SO-VID: 39e092f5-aed7-4358-b799-6870aef807ee
                Copyright © ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/

                History
                Date received : 6 February 2021
                Date revision received : 29 March 2021
                Date accepted : 16 June 2021
                Categories
                Subject: Minireviews

                Keywords: endoscopic full-thickness resection,exposed endoscopic full-thickness resection,full-thickness resection,natural orifice transluminal endoscopic surgery,endoscopic surgery,endoscopic suturing
                Data availability:
                Keywords: endoscopic full-thickness resection, exposed endoscopic full-thickness resection, full-thickness resection, natural orifice transluminal endoscopic surgery, endoscopic surgery, endoscopic suturing

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