PDF(Pubmed)
Abstract：
Exposed endoscopic full-thickness resection (Eo-EFTR) has been recognized as a feasible therapy for gastrointestinal submucosal tumours (SMTs) originating deep in the muscularis propria layer; however, Eo-EFTR is difficult to perform in a retroflexed fashion in the gastric fundus. As a supportive technique, clip- and snare-assisted traction may help expose the surgical field and shorten the operation time in endoscopic resection of difficult regions. However, the application of clip- and snare-assisted traction in Eo-EFTR of SMTs in the gastric fundus is limited. Between April 2018 and December 2021, Eo-EFTR with clip- and snare-assisted traction was performed in 20 patients with SMTs in the gastric fundus at The First Affiliated Hospital of Soochow University. The relevant clinical data were collected retrospectively for all of the patients and analysed. All 20 patients underwent Eo-EFTR successfully without conversion to open surgery or severe adverse events. The en bloc resection rate and R0 resection rate were both 100%. Two patients had abdominal pain and fever after the operation, and five patients had fever, which recovered with medical therapy. No complications, such as delayed bleeding or delayed perforation, were observed. The postoperative pathology indicated that 19 cases were gastrointestinal stromal tumours and one case was leiomyoma. During the follow-up, no residual tumour, local recurrence or distant metastasis was detected by endoscopy or abdominal computed tomography. In conclusion, Eo-EFTR with clip- and snare-assisted traction appears to be a relatively safe and effective treatment for gastric SMTs in the fundus. However, prospective studies on a larger sample size are required to verify the effect of the clip- and snare-assisted traction in Eo-EFTR.
摘要：
暴露的内窥镜全层切除术（Eo-EFTR）已被认为是起源于固有肌层深处的胃肠道粘膜下肿瘤（SMT）的可行疗法；但是，Eo-EFTR难以在胃底中以反折的方式进行。作为一种支持技术，在困难区域的内窥镜切除中，夹钳和圈套器辅助牵引可能有助于暴露手术区域并缩短手术时间。然而,钳和圈套辅助牵引在胃底SMTsEo-EFTR中的应用有限。在2018年4月至2021年12月期间，在苏州大学第一附属医院对20例胃底SMTs患者进行了Eo-EFTR的夹子和圈套辅助牵引。回顾性收集并分析所有患者的相关临床资料。所有20例患者均成功接受了Eo-EFTR，没有转换为开放手术或严重不良事件。整块切除率和R0切除率均为100%。两名患者术后出现腹痛和发热,五个病人发烧,通过药物治疗恢复了。无并发症,如延迟出血或延迟穿孔，被观察到。术后病理提示胃肠道间质瘤19例,平滑肌瘤1例。在后续行动中,没有残留肿瘤，通过内窥镜检查或腹部计算机断层扫描发现局部复发或远处转移。总之,Eo-EFTR与夹子和圈套器辅助牵引似乎是一种相对安全和有效的治疗胃底SMT的方法。然而,需要对更大样本量进行前瞻性研究,以验证快板和圈套器辅助牵引在Eo-EFTR中的效果.
