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Objective:To construct a deep learning-based diagnostic system for gastrointestinal submucosal tumor (SMT) under endoscopic ultrasonography (EUS), so as to help endoscopists diagnose SMT.Methods:From January 1, 2019 to December 15, 2021, at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University, 245 patients with SMT confirmed by pathological diagnosis who underwent EUS and endoscopic submucosal dissection were enrolled. A total of 3 400 EUS images were collected. Among the images, 2 722 EUS images were used for training of lesion segmentation model, while 2 209 EUS images were used for training of stromal tumor and leiomyoma classification model; 283 and 191 images were selected as independent test sets to evaluate lesion segmentation model and classification model, respectively. Thirty images were selected as an independent data set for human-machine competition to compare the lesion classification accuracy between lesion classification models and 6 endoscopists. The performance of the segmentation model was evaluated by indexes such as Intersection-over-Union and Dice coefficient. The performance of the classification model was evaluated by accuracy. Chi-square test was used for statistical analysis.Results:The average Intersection-over-Union and Dice coefficient of lesion segmentation model were 0.754 and 0.835, respectively, and the accuracy, recall and F1 score were 95.2%, 98.9% and 97.0%, respectively. Based on the lesion segmentation, the accuracy of classification model increased from 70.2% to 92.1%. The results of human-machine competition showed that the accuracy of classification model in differential diagnosis of stromal tumor and leiomyoma was 86.7% (26/30), which was superior to that of 4 out of the 6 endoscopists(56.7%, 17/30; 56.7%, 17/30; 53.3%, 16/30; 60.0%, 18/30; respectively), and the differences were statistically significant( χ2=7.11, 7.36, 8.10, 6.13; all P<0.05). There was no significant difference between the accuracy of the other 2 endoscopists(76.7%, 23/30; 73.3%, 22/30; respectively) and model(both P<0.05). Conclusion:This system could be used for the auxiliary diagnosis of SMT under ultrasonic endoscope in the future, and to provide a powerful evidence for the selection of subsequent treatment decisions.
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Objective: To analyze the clinicopathological and biological characteristics of esophageal submucosal tumors (SMTs) and to investigate the safety and efficacy of endoscopic resection for esophageal SMTs. Methods: We retrospectively analyzed the data of 152 cases of esophageal submucosal tumors resected by endoscopy in Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, from February 2013 to June 2018 as well as the pathological properties, distribution characteristics, origin and location of the esophageal SMTs. We also analyzed complications and efficacy of different methods for endoscopic resection. Results: The average age of onset of esophageal SMTs in this group was 52.74±10.53 years, without gender difference. Pathological features were as follows: leiomyoma was more common (73.68%), followed by stromal tumor (11.18%), hemangioma (3.95%), cyst (3.29%), and lipoma (1.97%). SMTs occurred mostly in the middle and lower segments of the esophagus. They were mainly located in the muscularis mucosa (31.58%) and muscularis propria (57.89%), and partly located in the submucosa (10.53%). Endoscopic resection methods consisted of endoscopic mucosal resection (EMR) performed in 36 cases, endoscopic submucosal dissection (ESD) in 52 cases, submucosal tunneling endoscopic resection (STER) in 63 cases, and full-thickness resection (EFTR) in 1 case. All lesions were completely resected. EMR had small tumor resection and shorter operative time; ESD and STER showed large tumor resection and long operation time (P0.05). Complications were effectively controlled. No local recurrence or residual cases were found in postoperative follow-up. Conclusion: Adult onset of submucosal tumors of the esophagus, without gender difference, can occur in all segments of the esophagus, mostly from the mucosal muscularis and muscularis propria. Leiomyoma is common, followed by stromal tumor, spindle cell tumor, and hemangioma. Endoscopic resection depends on the lesion location, source and size, and endoscopic treatment is safe and effective.
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Objective To investigate the efficacy and limitation of endoscopic ultrasonography (EUS) on the diagnosis of gastrointestinal submucosal tumor (SMT) prior to endoscopic resection.Methods Data of 211 patients,who were confirmed as gastrointestinal SMT before operation and received endoscopic resection for gastrointestinal submucosal tumor at Department of Gastroenterology,Shanghai Ruijin Hospital from January 2016 to December 2018 were analyzed.The value and limitation of EUS for SMT were investigated according to the final pathology.Results For the lesion distribution,66 were in esophagus,108 in stomach,2 in duodenum and 35 in rectum.The accuracy of tumor origin by EUS was 99.5％ (210/211).The accuracy of tumor nature by EUS was 75.8％ (160/211).For the lesions originated from different locations,the diagnostic accuracy for lesion originated from esophageal mucosa/submucosa,esophageal muscularis propria,gastric mucosa/submucosa,gastric muscularis propria,duodenal submucosa,rectal mucosa/submucosa by EUS were 90.0％ (54/60),83.3％ (5/6),31.0％ (13/42),89.4％ (59/66),50.0％(1/2),82.9％ (29/35),respectively.With respect to hypoechoic lesions,leiomyoma,leiomyoma/gastrointestinal stromal tumor,and neuroendocrine tumor were the predominant type of tumor originated from esophageal mucosa,gastrointestinal muscularis propria and rectal mucosa/submucosal,respectively.Conclusion Although EUS is indispensible for the diagnosis of gastrointestinal submucosal tumor,it plays a limited role in the differential diagnosis of various lesions originated from gastric mucosa and submucosa.Since part of the submucosal tumors may be potential for malignant development,an diagnosis made by EUS should be more careful.
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Resumen Introducción Los tumores submucosos del tracto gastrointestinal alto tienen potencial de malignidad y también pueden ser una carga para el paciente, por lo que se requiere disponer de un tratamiento seguro y eficaz. El surgimiento de la técnica de resección endoscópica por tunelización submucosa (STER) en los últimos años ha mostrado resultados prometedores. Caso clínico Se presenta el caso de un hombre de 47 años asintomático, en quien, en el contexto de un estudio preoperatorio de cirugía bariátrica, se pesquisa una lesión subepitelial en la unión gastroesofágica. La endosonografía alta es compatible con un leiomioma esofágico. Se realiza STER con éxito y sin complicaciones; a las 48 h es dado de alta. El estudio histopatológico confirmó un leiomioma esofágico. Discusión La técnica STER ha demostrado consistentemente ser segura y eficaz en el tratamiento de los tumores submucosos de la unión gastroesofágica. El desafío es difundir la técnica por el resto del país, para mayor beneficio de los pacientes.
Introduction Upper gastrointestinal submucosal tumors are potentially malignant lesions; so safe and efficient treatments are needed. In recent years, submucosal tunneling endoscopic resection (STER) has emerged as a novel therapeutic technique, with promising results. Case report 47-year-old male patient, previously asymptomatic, who was found to have a subepithelial lesion at the gastroesophageal junction. Upper endoscopic ultrasound was compatible with a leiomyoma. He underwent STER to remove the tumor and recovered with any complications. The biopsy confirmed an esophageal leiomyoma. Discussion STER has become a highly feasible and safe therapeutic option for submucosal tumors of the gastroesophageal junction. The challenge is to spread knowledge about this technique, to maximize patient's benefit.
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Humans , Male , Middle Aged , Esophageal Neoplasms/surgery , Endoscopic Mucosal Resection/methods , Leiomyoma/surgery , Treatment Outcome , Mucous Membrane/surgeryABSTRACT
Objective To explore the clinical value of dental floss traction-assisted endoscopic full-thickness resection ( EFTR) for muscularis propria tumor in gastric fundus. Methods Twenty-four patients with muscularis propria tumor in gastric fundus and undergoing EFTR with traction of dental floss from January to December in 2016 in Endoscopy Center of Zhongshan Hospital were enrolled in the trial group. Another 24 patients undergoing traditional EFTR from January to December in 2015 were enrolled in the control group. The control group was paired with the trial group according to tumor size. The differences in tumor resection time, hospitalization time, and complication rate were compared between the two groups. Results There were no significant differences in the mean age and gender composition between the two groups ( both P>0. 05) . The tumor resection time of the trial group was shorter than that of the control group ( 10. 8 ± 2. 8 min VS 19. 0 ± 4. 7 min, t = 7. 298, P<0. 05 ) . There was no significant difference in postoperative hospital stay between the two groups ( 3. 2 ± 0. 5 days VS 3. 2 ± 0. 5 days, t=0. 291, P=0. 772) . No postoperative delayed bleeding or perforation and other complications occurred in the two groups. Conclusion Dental floss traction-assisted EFTR is safe and effective to treatment of muscularis propria tumors in gastric fundus, which can expose the tumor boundary, so that the surgical level may be clearer to simplify the operation and reduce the tumor resection time.
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Objective To investigate the clinical efficacy and application value of submucosal tunneling endoscopic resection(STER)for upper gastrointestinal submucosal tumors(SMTs). Methods A retrospective analysis was performed on the endoscopic and clinical data of 44 cases with SMTs who received STER from January 2015 to June 2016 in Chinese PLA General Hospital. Results The rate of complete resection was 88.6%(39/44). The operating time was 60.1±30.6 min. The hospitalization time was 10.1± 3.3 days. The rate of complications was 6.8%(3/44). The diagnosis of SMTs by pathology and endoscopic ultrasonography(EUS),the size of SMTs measured by EUS and ruler after STER,and the growing direction judged by EUS and CT were consistent. Conclusion STER for SMTs has a higher complete resection rate, shorter operating time and hospitalization time, and fewer complications. EUS combined with CT is an effective method for preoperative evaluation.
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Objective To explore the therapeutic effect and safety of endoscopic multi-band mucosetomy (EMBM) and endoscopic submucosal dissection(ESD) for colorectal submucosal tumors under the guidance of ultrasound endoscopy. Methods From January 2013 to June 2016,the clinical data of sixty patients with colorectal submucosal tumors in Center People's Hospital of Tengzhou who received either EMBM (32 cases) or ESD ( 28 cases) were included in this retrospective study. The complete resection rate, average diameter of resection lesion, operative time, complications and recurrence rate of two groups were compared. Results The complete resection rate of EMBM groups was 96. 9%(31/ 32),the complete resection rate of ESD groups was 96. 4%(27/ 28),there was no statistically significant difference between the two groups (χ2 = 0. 07,P= 0. 812). The average diameter of was ESD group (12. 3±2. 6) mm,significantly greater than that of EMBM group ((9. 1± 2. 2) mm) (P = 0. 038),and the mean operation time of EMBM group was (20. 5 ±5. 1) min,which was significantly less than that of ESD group ( (36. 8±4. 5) min) (P = 0. 008),and the percentage of perforation in EMBM group was 0,significantly lower than that of ESD group (10. 7%(3/ 28))(χ2 = 6. 37, P = 0. 013). The severe bleeding rate of EMBM group was 3. 1% (1/ 32),which was significantly lower than that in ESD group(14. 3%(4/ 28)) (χ2 = 4. 89, P = 0. 021) . After 6-12 months of follow-up,no recurrence or distant metastasis was found in EMBM or ESD group. Conclusion EMBM and ESD are safe and effective for colorectal submucosal tumors,However the average diameter of the lesion was larger in EMBM group than that in ESD group.
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Objective To study the value of endoscopic treatment for patients with gastric submucosal tumor ( G-SMT ) . Methods The data of 1663 patients with G-SMT undergoing endoscopic treatment was retrospective reviewed from January 2008 to December 2013. Patients′ demographics, treatment outcomes, and follow-up were evaluated. Results A total of 1671 lesions of G-SMT were included in the study. The mean maximum size of lesions was (1. 50±1. 02) cm. Twenty lesions were treated by endoscopic mucosal resection, 296 lesions by endoscopic submucosal dissection (ESD), 7 lesions by ESD+nylon endoloop, 1011 lesions by endoscopic submucosal excavation, 44 lesions by submucosal tunneling endoscopic resection, and 285 lesions by endoscopic full-thickness resection. Endoscopic treatment failed in 8 cases. Postoperative pathology diagnosis included 554 liomyoma, 485 gastrointestinal stromal tumors, 160 ectopic pancreas, and other such as lipoma, neuroendocrine tumor and fibroma. There were 16 cases of bleeding and 18 cases of perforation after treatment. Except for 4 cases of bleeding and 2 cases of perforation underwent additional surgical procedures, all patients were managed by conservative treatments. During a median follow-up time of 36 months of 1226 cases, the recurrence rate was 1％( 12/1226) ,and no death occurred. Conclusion Endoscopic treatment is safe and effective in treating G-SMT for long-term outcomes.
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Objective To investigate the spatio-temporal characteristics of normal gastric electrical activity.Methods From January 1st to February 29th,2016,fasting gastric electric slow wave signal was collected by high resolution mapping (HRM) under anesthesia before operation in patients without gastric lesions but needed laparoscopic surgery.Parameters of slow wave signal activity was calculated,gastric activity map and velocities was drawn and then spatio-temporal characteristics of gastric electrical activity of different part of the stomach were obtained.Independent sample t test was performed for comparison of two groups and one-way analysis of variance was used for multiple group comparisons.Results The normal gastric pacing zone located in the upper middle part of gastric body near greater curvature.Electrical activity of gastric body spread to gastric antrum along the long axis of the stomach.No slow signal was recorded in the gastric fundus and the gastric cardia.The frequencies of slow waves of different parts of gastric was same and the mean value was 2.61 ±0.11 cycle per minute.Compared with that of gastric body,the slow wave amplitude of gastric pacing zone was higher ((4.19±0.73) mV vs (1.67± 0.89) mV) and the speed was faster (7.24± 1.37) mm/s vs (4.94± 0.20) mm/s);the differences were statistically significant (t=18.89 and 4.95,both P＜0.01).The slow wave amplitude of gastric antrum was higher than that of gastric body ((3.21±0.49) mV vs (1.67±0.89) mV) and the speed was also faster ((6.44±0.82) mm/s vs (4.94±0.20) mm/s);the differences were statistically significant (t=4.85 and 4.95,both P＜0.05).The slow wave amplitude of gastric antrum was lower than that of pacemaker area ((3.21±0.49) mV vs (4.19±0.73) mV),and the difference was statistically significant (t =-3.67,P＜0.05);however,there was no significant difference in wave velocity ((6.44±0.82) mm/s vs (7.24±1.37) mm/s,P＞0.05).Conclusions The normal human gastric pacemaker is located in mid and upper corpus near the greater curvature,which produces slow wave and control whole gastric electrical activity.The amplitude and velocity of slow waves are in gradient changes in different gastric regions.HRM is a mature and reliable research method to study the spatio-temporal characteristics of gastric electrical activity,which provides the possibility for the study of abnormal gastric electrical activity.
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Objective To evaluate the efficacy and safety of single forcep endoscopic purse-string suture closing the wound of cardia and gastric fundus after endoscopic full-thickness resection (EFTR) for patients with submucosal tumor (SMT).Methods The clinical data of 32 patients with wound in the cardia and gastric fundus after EFTR for SMT undergoing single forcep endoscopic purse-string suture in Endoscopy Center of Renmin Hospital of Wuhan University from January 2015 to January 2016 were collected.Completion of operation, postoperative complication and follow-up results of these patients were retrospectively analyzed.Results All of the patients successfully received EFTR and purse-string suture.The maximal diameter of tumors was 1-4 cm.The suture time was 10-15 min, and postoperative hospital stay was 5-10 d.Low fever and upper abdominal pain were found in 13 and 20 cases respectively, and all cases were alleviated or restored after conservative treatment.All patients underwent gastroscopy during follow-up of 1 month, and titanium clip and nylon rope were found on the wound surface in 29 cases (90.6%).Three months after operation, 28 patients underwent gastroscopy, and titanium clip but no nylon rope was detected in 15 cases (46.9%).Conclusion Single forcep endoscopic purse-string suture can effectively treat the postoperative wound in the cardia and gastric fundus of patients with submucosal tumors after EFTR.
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Objective To investigate the spatio-temporal characteristics of normal gastric electrical activity.Methods From January 1st to February 29th,2016,fasting gastric electric slow wave signal was collected by high resolution mapping (HRM) under anesthesia before operation in patients without gastric lesions but needed laparoscopic surgery.Parameters of slow wave signal activity was calculated,gastric activity map and velocities was drawn and then spatio-temporal characteristics of gastric electrical activity of different part of the stomach were obtained.Independent sample t test was performed for comparison of two groups and one-way analysis of variance was used for multiple group comparisons.Results The normal gastric pacing zone located in the upper middle part of gastric body near greater curvature.Electrical activity of gastric body spread to gastric antrum along the long axis of the stomach.No slow signal was recorded in the gastric fundus and the gastric cardia.The frequencies of slow waves of different parts of gastric was same and the mean value was 2.61 ±0.11 cycle per minute.Compared with that of gastric body,the slow wave amplitude of gastric pacing zone was higher ((4.19±0.73) mV vs (1.67± 0.89) mV) and the speed was faster (7.24± 1.37) mm/s vs (4.94± 0.20) mm/s);the differences were statistically significant (t=18.89 and 4.95,both P＜0.01).The slow wave amplitude of gastric antrum was higher than that of gastric body ((3.21±0.49) mV vs (1.67±0.89) mV) and the speed was also faster ((6.44±0.82) mm/s vs (4.94±0.20) mm/s);the differences were statistically significant (t=4.85 and 4.95,both P＜0.05).The slow wave amplitude of gastric antrum was lower than that of pacemaker area ((3.21±0.49) mV vs (4.19±0.73) mV),and the difference was statistically significant (t =-3.67,P＜0.05);however,there was no significant difference in wave velocity ((6.44±0.82) mm/s vs (7.24±1.37) mm/s,P＞0.05).Conclusions The normal human gastric pacemaker is located in mid and upper corpus near the greater curvature,which produces slow wave and control whole gastric electrical activity.The amplitude and velocity of slow waves are in gradient changes in different gastric regions.HRM is a mature and reliable research method to study the spatio-temporal characteristics of gastric electrical activity,which provides the possibility for the study of abnormal gastric electrical activity.
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PURPOSE: Extraosseous Ewing's sarcoma (EOE) of the rectum is extremely rare: only three cases have been reported in the literature and none of these reports described their imaging findings in detail. Herein, we describe the tumor imaging and pathological features in detail. MATERIALS AND METHODS: We report a case of rectal EOE in a 72-year-old female who received local excision and was provisionally diagnosed with a rectal submucosal spindle cell tumor. We used immunohistochemistry, histopathology, and fluorescence in situ hybridization to characterize the tumor and provide a definitive diagnosis of EOE. RESULTS: MRI revealed a well-demarcated submucosal tumor with heterogeneous enhancement and hemorrhagic foci in rectum. EOE was diagnosed by positive staining of tumor cells for CD99 and Fli-1 by immunohistochemistry and the presence of the EWSR1 gene translocation by fluorescence in situ hybridization. Although the patient underwent radiation treatment and surgery, the tumor recurred after 4 months as revealed by computed tomography and magnetic resonance imaging. CONCLUSION: Rectal EOE may present as a rectal submucosal tumor. The understanding of imaging and histological characteristics of this tumor are critical for accurate diagnosis and appropriate aggressive treatment.
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Aged , Female , Humans , Diagnosis , Fluorescence , Immunohistochemistry , In Situ Hybridization , Magnetic Resonance Imaging , Rectum , Sarcoma, EwingABSTRACT
The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
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Adult , Humans , Carcinoid Tumor , Colonoscopy , Germinal Center , Lymphoid Tissue , Lymphoma, B-Cell, Marginal Zone , Palatine Tonsil , Rectum , TwinsABSTRACT
Submucosal tumors (SMTs) originate from tissues that constitute the submucosal layer and muscularis propria, and are covered by normal mucosa. Esophageal SMTs are rare, accounting for <1% of all esophageal tumors. However, the recent widespread use of endoscopy has led to a rapid increase in incidental detection of SMTs in Korea. Esophageal SMTs are benign in ≥90% of cases, but the possibility of malignancies such as gastrointestinal stromal tumor and malignant leiomyosarcoma still exists. Therefore, patients undergo resection in the presence of symptoms or the possibility of a malignant tumor. For resection of esophageal SMTs, surgical resection was the only option available in case of possible malignancy, but minimally invasive surgery by endoscopic resection is becoming more preferable to surgical resection with the development of endoscopic ultrasonography, endoscopic techniques, and other devices.
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Humans , Endoscopy , Endosonography , Gastrointestinal Stromal Tumors , Korea , Leiomyosarcoma , Minimally Invasive Surgical Procedures , Mucous MembraneABSTRACT
BACKGROUND/AIMS: In recent years, endoscopic submucosal tunnel dissection (ESTD) has gained popularity worldwide. The aim of this study was to evaluate the safety and efficacy of ESTD in treating upper gastrointestinal submucosal tumors (SMTs) in a large-volume endoscopic center. METHODS: Patients with SMTs were enrolled in this study between January 2012 and January 2015. Demographic data, clinical data, and treatment outcome were collected and analyzed. RESULTS: Seventy SMTs originating from the muscularis propria (MP) layer were identified in 69 patients. All patients successfully underwent the ESTD procedure. The mean procedure time was 49.0±29.5 minutes, and the mean tumor size was 18.7±7.2 mm. Among all lesions, the majority (70.0%) were located in the esophagus, 12.9% in the cardia, and 17.1% in the stomach. Complete resection was achieved in 67 lesions (95.7%). Perforation occurred in three patients (4.3%), who were treated by endoclips. Pneumothorax occurred in two patients (2.9%) and was successfully managed by thoracic drainage. During a median follow-up of 18.1 months, patients were free of local recurrence or distant metastasis. CONCLUSIONS: Our results demonstrated the feasibility and safety of ESTD in treating upper gastrointestinal SMTs originating from the MP layer. Large-scale comparative studies with other treatment methods should be conducted in the future.
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Humans , Cardia , Drainage , Esophagus , Follow-Up Studies , Neoplasm Metastasis , Pneumothorax , Recurrence , Stomach , Treatment OutcomeABSTRACT
Objective To evaluate the efficacy of a new endoscopic suturing device(OverStitchTM, Apollo Endosurgery, USA)for gastrointestinal wall defect after endoscopic full?thickness resection (EFTR). Methods Clinical data of the patients with submucosal tumors who underwent endoscopic suturing closure of gastrointestinal wall defect at the Endoscopy Center of Zhongshan Hospital from April 2015 to June 2015 were retrospectively analyzed. Results Five patients were included in this research with 4 lesions located in stom?ach and 1 lesion located in descendent duodenum. The mean diameter of lesions was 3?? 2 cm (ranging 2?? 0?5?? 0 cm). All patients underwent complete closure and none of them was converted to laparoscopic surgery or laparotomy. The mean repairing time was 16?? 6 min (ranging 11?? 0?22?? 0 min). The mean postoperative hospi?talization time was 5 days ( ranging 4?6 d). Two patients complained about slight abdominal pain and elevated body temperature. CT showed minor pleural effusion in one case. These patients received antibiotics, were on gastrointestinal decompression and asked to maintain the semi?supine position and discharged after 3 to 4 days. Conclusion Endoscopic suturing closure of gastrointestinal wall defect with the OverStitchTM en?doscopic suturing device is technically fast, feasible and safe.
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Objective To evaluate a new type of endoloop for closure of full-thickness gastric defects left by EFR.Methods A total of 32 patients who underwent EFR at our hospital between October 2014 and February 2015 with gastric fundus submucosal tumors were retrospectively analyzed.After the resection,LeCampTM endoloops and Olympus endoloops were used respectively to close the gastric defect in the study group (n =14) and the control group(n =18).The closure success rates,closure time,complications and the healing rates were compared.Results All lesions were removed by using EFR technique.The closure success rates of the two groups were both 100％.The closure time were 13.86 ± 4.62 minutes and 18.28 ± 6.48 minutes in study group and control group respectively with significant difference (P ＜ 0.05).9.43 ±4.09 metallic clips and 1.00 ±0.00 endoloops were used in study group and 9.67 ± 3.61 metallic clips and 1.06 ± 0.24 endoloops were used in control group (P ＞ 0.05).One patient in study group and 2 patients in control group received abdominal puncture for relieving the pneumoperitoneum during the operation (P ＞ 0.05).No complications such as subcutaneous emphysema,pneumothorax,pneumomediastinum,delayed bleeding,or abdominal infection were found after the operations in either group.The wounds healed in all patients in 2 months after the procedure.Conclusion The use of novel endoloop and metallic clips is a relatively safe,easy,and feasible method for repairing large gastric post-EFR defects,which is of good clinical application value.
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PURPOSE: Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors. MATERIALS AND METHODS: Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy. RESULTS: All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was 139.2+/-30.9 minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was 7.7+/-0.8 days. CONCLUSIONS: ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.
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Humans , Academic Medical Centers , Anesthesia, General , Endoscopy , Esophagogastric Junction , Gastrointestinal Stromal Tumors , Leiomyoma , Length of Stay , Mortality , Stomach , UltrasonicsABSTRACT
BACKGROUND AND AIMS: In recent years, submucosal tunneling endoscopic resection (STER) was applied more and more often for single gastrointestinal (GI) submucosal tumor (SMT). However, little is known about this technique for treating multiple SMTs in GI tract. In the present study, we investigated the feasibility and outcome of STER for upper GI multiple SMTs originating from the muscularis propria (MP) layer. PATIENTS AND METHODS: A feasibility study was carried out including a consecutive cohort of 23 patients with multiple SMTs from MP layer in esophagus, cardia, and upper corpus who were treated by STER from June 2011 to June 2014. Clinicopathological, demographic, and endoscopic data were collected and analyzed. RESULTS: All of the 49 SMTs were resected completely by STER technique. Furthermore, only one tunnel was built for multiple SMTs of each patient in this study. En bloc resection was achieved in all 49 tumors. The median size of all the resected tumors was 1.5 cm (range 0.8–3.5 cm). The pathological results showed that all the tumors were leiomyoma, and the margins of the resected specimens were negative. The median procedure time was 40 min (range: 20–75 min). Gas‑related complications were of the main complications, the rates of subcutaneous emphysema and pneumomediastinum, pneumothorax, and pneumoperitoneum were 13.0%, 8.7% and 4.3%. Another common complication was thoracic effusion that occurred in 2 cases (8.7%), among which only 1 case (4.3%) with low‑grade fever got the drainage. Delayed bleeding, esophageal fistula or hematocele, and infection in tunnel were not detected after the operation there were no treatment‑related deaths. The median hospital stay was 4 days (range, 2–9 days). No residual or recurrent lesion was found during the follow‑up period (median 18, ranging 3–36 months). CONCLUSION: Submucosal tunneling endoscopic resection is a safe and efficient technique for treating multiple esophageal SMTs originating from MP layer, which can avoid patients suffering repeated resections.
Subject(s)
Endoscopy/methods , Esophagoscopy/methods , Gastric Mucosa/pathology , Gastrointestinal Neoplasms/pathology , Gastrointestinal Neoplasms/surgery , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/surgery , Humans , Muscles/pathologyABSTRACT
Objective To investigate the diagnostic value of endoscopic ultrasonography( EUS)for gastrointestinal submucosal tumors. Methods EUS was performed on 378 patients with submucosal tumor detected by endoscopy. The shape,number,origin,and property were recorded under endoscopic ultrasonogra-phy. The diagnostic consistent rate was calculated with pathology as the golden standard. Results Among 378 patients,there were 131 cases of gastrointestinal leiomyoma,mostly low echo( n=87 ),homogeneous echo (n=119),and originated from muscular layer of mucosa(n=92). There were 111 cases of gastrointestinal stromal tumor,mainly low echo(n=51),medium low echo(n=51),homogeneous echo(n=78),originated from muscularis propria(n=85). There were also 50 cases of carcinoid tumor,mainly low echo(n=36), originated from submucosa(n=27). Forty-five cases of lipoma were detected,also originated from submuco-sa,mainly hyperecho(n=40),homogeneous echo(n=41). Heterotopic pancreas(n=19),schwannoma (n=4),and granular cell tumor(n=4)were relatively rare. Overall diagnostic consistent rate of EUS in submucosal tumor was 78. 6%( 297/378 ),diagnostic consistent rate of the shape of the tumor was 91. 8%(347/378),diagnostic consistent rate of the number was 95. 5%(361/378),and the consistent rate of origin was 96. 8%(366/378). Conclusion All kinds of submucosal tumor have certain features under endoscopic ultrasonography. Endoscopic ultrasonography can display echo,size,origin of gastrointestinal submucosal tumors,as well as their relations with the wall layer in gastrointestinal tract. It plays an important role in the diagnosis,differential diagnosis and treatment options,but there are still some limitations.