Effect of endoscopic full-thickness resection assisted by distal serosal turnover with floss traction for gastric submucosal masses.

BACKGROUND: Complex and high-risk surgical complications pose pressing challenges in the clinical implementation and advancement of endoscopic full-thickness resection (EFTR). Successful perforation repair under endoscopy, thereby avoiding surgical intervention and postoperative complications such as peritonitis, are pivotal for effective EFTR. AIM: To investigate the effectiveness and safety of EFTR assisted by distal serosal inversion under floss traction in gastric submucosal tumors. METHODS: A retrospective analysis of patients with gastric and duodenal submucosal tumors treated with EFTR assisted by the distal serosa inversion under dental floss traction from January 2023 to January 2024 was conducted. The total operation time, tumor dissection time, wound closure time, intraoperative bleeding volume, length of hospital stay and incidence of complications were analyzed. RESULTS: There were 93 patients, aged 55.1 ± 12.1 years. Complete tumor resection was achieved in all cases, resulting in a 100% success rate. The average total operation time was 67.4 ± 27.0 min, with tumor dissection taking 43.6 ± 20.4 min. Wound closure times varied, with gastric body closure time of 24.5 ± 14.1 min and gastric fundus closure time of 16.6 ± 8.7 min, showing a significant difference (P < 0.05). Intraoperative blood loss was 2.3 ± 4.0 mL, and average length of hospital stay was 5.7 ± 1.9 d. There was no secondary perforation after suturing in all cases. The incidence of delayed bleeding was 2.2%, and the incidence of abdominal infection was 3.2%. No patient required other surgical intervention during and after the operation. CONCLUSION: Distal serosal inversion under dental-floss-assisted EFTR significantly reduced wound closure time and intraoperative blood loss, making it a viable approach for gastric submucosal tumors.

The effect of endoscopic ultrasound on the precise selection of endoscopic treatment for submucosal tumors in the upper gastrointestinal tract.

OBJECTIVE: To summarize and discuss the guiding role of endoscopic ultrasound (EUS) in selecting endoscopic treatments for submucosal tumors (SMTs) in the upper gastrointestinal tract. METHODS: A retrospective investigation was conducted on 156 SMT patients who received endoscopic resection guided by EUS in the endoscopy center of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2019 to September 2021. Next, the size, pathological type, and distribution of lesions were analyzed; the correlation of the tumor origin with distribution of lesions and selection of treatments was explored; and the consistency of preoperative EUS diagnosis and postoperative pathological diagnosis was summarized and analyzed. RESULTS: The tumor diameters of the included SMT patients ranged from 0.3 to 4 cm, with a mean diameter of 0.95 cm; the lesions were mostly located in the esophagus, gastric fundus or fundic cardia and gastric body. As for the pathological types, liomyoma was the most common tumor in the esophagus, liomyoma and mesenchymoma were mainly located in the fundic cardia and gastric body, and heterotopic pancreas was mostly discovered in the gastric sinus. Among 38 esophageal SMT patients, some with lesions originating from muscularis mucosa and submucosa under EUS mainly underwent endoscopic submucosal dissection (ESD) and endoscope band ligation (EBL); while others with lesions originated from muscularis propria mainly received submucosal tunneling endoscopic resection (STER). Of 115 gastric SMT patients under EUS, some with lesion origins from the muscularis mucosa and submucosa mainly underwent endoscopic submucosal excavation (ESE), while others from muscularis propria mainly underwent ESE, ESD, and endoscopic full-thickness resection (EFTR). Besides, 3 duodenal SMT patients with lesion origins from submucosa and muscularis propria under EUS were given ESD and ESE, respectively. Additionally, 121 cases showed a consistency between the EUS diagnosis and the postoperative pathological nature, and the consistency rate was 84.6%. CONCLUSION: Clarifying the origin layer, size, growth pattern, and pathological nature of the lesion through preoperative EUS can guide the precise selection of endoscopic treatments, thereby ensuring a safe, effective, and complete surgical outcomes and reducing complications.

Comparison of laparoscopic versus open liver resection for lesions located in posterosuperior segments: a meta-analysis of short-term and oncological outcomes.

BACKGROUND: The role of laparoscopic liver resection (LLR) for lesions located in posterosuperior (PS) segments remains a matter of development to be further assessed. This systematic review aims to compare the short-term and oncological outcomes between laparoscopic and open liver resection (OLR) in PS lesions. METHODS: EMBASE, MEDLINE and Cochrane Library were searched from date of inception to June 2019. This meta-analysis was performed using the STATA 12.0 statistical software. Standardized mean differences (SMDs), odds ratios (ORs) and hazard ratios (HRs) were calculated for continuous variables, dichotomous variables and long-term variables, respectively, with 95% confidence intervals (CIs). RESULTS: A total of 788 patients from eight studies were identified for the final analysis, with 371 patients in the LLR group and 417 in the OLR group. Although the operation time (SMD 0.22; 95% CI 0.08-0.36; P = 0.003) was longer whereas overall complication rate (OR 0.50; 95% CI 0.36-0.70; P < 0.001) and postoperative hospital stay (SMD - 0.45; 95% CI - 0.59 to - 0.30; P = 0.003) were lower in the LLR group than in the OLR group, no significant differences in blood loss (SMD - 0.14; 95% CI - 0.28 to 0.00; P = 0.054), transfusion rate (OR 0.92; 95% CI 0.56-1.54; P = 0.764), major complication rate (OR 0.63; 95% CI 0.38-1.05; P = 0.079), R0 resection rate (OR 1.04; 95% CI 0.55-1.96; P = 0.902), and disease-free survival (DFS) for hepatocellular carcinoma (HCC) (HR 1.43; 95% CI 0.95-2.17), DFS for colorectal liver metastases (HR 1.05; 95% CI 0.61-1.81), overall survival for HCC (HR 1.00; 95% CI 0.43-2.30) were noted between the groups. CONCLUSION: LLR is technically feasible and safe without compromising long-term oncological outcomes for selected patients with lesions in the PS segments of the liver.