Laparoscopy-assisted endoscopic full-thickness resection of gastric subepithelial tumors using a nonexposure technique

Osamu Goto; Hiroya Takeuchi; Motoki Sasaki; Hirofumi Kawakubo; Teppei Akimoto; Ai Fujimoto; Yasutoshi Ochiai; Tadateru Maehata; Toshihiro Nishizawa; Yuko Kitagawa; Naohisa Yahagi

doi:10.1055/s-0042-111000

Endoscopy, Inhaltsverzeichnis

Endoscopy 2016; 48(11): 1010-1015
DOI: 10.1055/s-0042-111000

Innovations and brief communications

Laparoscopy-assisted endoscopic full-thickness resection of gastric subepithelial tumors using a nonexposure technique

Osamu Goto

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Hiroya Takeuchi

²Department of Surgery, Keio University School of Medicine, Tokyo, Japan

,

Motoki Sasaki

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Hirofumi Kawakubo

²Department of Surgery, Keio University School of Medicine, Tokyo, Japan

,

Teppei Akimoto

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Ai Fujimoto

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Yasutoshi Ochiai

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Tadateru Maehata

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Toshihiro Nishizawa

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Yuko Kitagawa

²Department of Surgery, Keio University School of Medicine, Tokyo, Japan

,

Naohisa Yahagi

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

› Institutsangaben

Abstract

Background and study aims: To avoid bacterial contamination and tumor seeding during gastrectomy surgery, we developed a nonexposure technique for endoscopic full-thickness resection with laparoscopic assistance. The feasibility and safety of nonexposed endoscopic wall-inversion surgery (NEWS) for gastric subepithelial tumors (SETs) were investigated.

Patients and methods: For protruding gastric SETs ≤ 3 cm in diameter, NEWS was performed in the following sequence: laparoscopic seromuscular incision after endoscopic submucosal injection, laparoscopic seromuscular suturing with the lesion inverted, endoscopic mucosal and submucosal incision, and transoral retrieval. Technical outcomes and postoperative courses were investigated.

Results: In all 20 consecutive cases, including six SETs with ulceration, NEWS was completed (mean procedural time, 213.5 minutes) without severe intraoperative or postoperative adverse events. R0 resection and perforation rates were 100 % and 5.0 %, respectively. During the mean observational period of 10.1 months, all patients survived without recurrence or apparent discomfort during food intake.

Conclusion: NEWS for gastric SETs was feasible and safe and represents a useful option for minimally invasive local resection even in cases of SETs with ulceration or cancers.

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Referenzen

References
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