Clinical Endoscopy

Original Articles

Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea: Yuri Kim, Ji Yong Ahn, Hwoon-Yong Jung, Seokin Kang, Ho June Song, Kee Don Choi, Do Hoon Kim, Jeong Hoon Lee, Hee Kyong Na, Young Soo Park; Clin Endosc 2024;57(3):350-363. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.144

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Background
/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs.
Methods
Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed.
Results
Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group.
Conclusions
cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.

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Endoscopic resection penetrating the muscularis propria for gastric gastrointestinal stromal tumors: advances and challenges
Jin Woong Cho
Clinical Endoscopy.2024; 57(3): 329. CrossRef

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Comparison of diagnostic performances of slow-pull suction and standard suction in endoscopic ultrasound-guided fine needle biopsy for gastrointestinal subepithelial tumors: Joon Seop Lee, Chang Min Cho, Yong Hwan Kwon, An Na Seo, Han Ik Bae, Man-Hoon Han; Clin Endosc 2022;55(5):637-644. Published online August 17, 2022; DOI: https://doi.org/10.5946/ce.2021.257

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Background
/Aims: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs.
Methods
In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques.
Results
The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis.
Conclusions
SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.

Citations

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Endoscopic ultrasound-guided fine-needle aspiration for gastrointestinal subepithelial lesions
Takuto Hikichi, Minami Hashimoto, Takumi Yanagita, Tsunetaka Kato, Jun Nakamura
Journal of Medical Ultrasonics.2024; 51(2): 195. CrossRef
What method can we choose if rapid on-site evaluation is not available for the endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions?
Yu Kyung Cho
Clinical Endoscopy.2024; 57(1): 53. CrossRef
The Diagnostic Approach of Benign Esophageal Tumors: A Narrative Review
Alex R. Jones, Preksha Vankawala, Tarek Sawas
Current Treatment Options in Gastroenterology.2024; 22(2): 44. CrossRef
Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
Gastrointestinal Endoscopy.2024; 99(6): 895. CrossRef
EUS‐guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided
Suprabhat Giri, Sridhar Sundaram
Australasian Journal of Ultrasound in Medicine.2024;[Epub] CrossRef
An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
Clinical Endoscopy.2023; 56(6): 744. CrossRef

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Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study: Sun Moon Kim, Eun Young Kim, Jin Woong Cho, Seong Woo Jeon, Ji Hyun Kim, Tae Hyeon Kim, Jeong Seop Moon, Jin-Oh Kim, the Research Group for Endoscopic Ultrasound of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2021;54(6):872-880. Published online November 18, 2021; DOI: https://doi.org/10.5946/ce.2021.251

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Background
/Aims: The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.
Methods
We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.
Results
Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.
Conclusions
The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.

Citations

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Results of the interim analysis of a prospective, multicenter, observational study of small subepithelial lesions in the stomach
Masaya Iwamuro, Toshiharu Mitsuhashi, Tomoki Inaba, Kazuhiro Matsueda, Teruya Nagahara, Yoji Takeuchi, Hisashi Doyama, Masakatsu Mizuno, Tomoyuki Yada, Yoshinari Kawai, Jun Nakamura, Minoru Matsubara, Hiroko Nebiki, Keiko Niimi, Tatsuya Toyokawa, Ryuta Ta
Digestive Endoscopy.2024; 36(3): 323. CrossRef
Diagnostic Endoscopic Ultrasound (EUS) of the Luminal Gastrointestinal Tract
Giovanna Impellizzeri, Giulio Donato, Claudio De Angelis, Nico Pagano
Diagnostics.2024; 14(10): 996. CrossRef
Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours
Socrate Pallio, Stefano Francesco Crinò, Marcello Maida, Emanuele Sinagra, Vincenzo Francesco Tripodi, Antonio Facciorusso, Andrew Ofosu, Maria Cristina Conti Bellocchi, Endrit Shahini, Giuseppinella Melita
Cancers.2023; 15(4): 1285. CrossRef
Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis
Rômulo Sérgio Araújo Gomes, Guilherme Henrique Peixoto de Oliveira, Diogo Turiani Hourneaux de Moura, Ana Paula Samy Tanaka Kotinda, Carolina Ogawa Matsubayashi, Bruno Salomão Hirsch, Matheus Oliveira Veras, João Guilherme Ribeiro Jordão Sasso, Roberto Pa
World Journal of Gastrointestinal Endoscopy.2023; 15(8): 528. CrossRef
Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
Clinical Endoscopy.2023; 56(6): 744. CrossRef
Significance of Ultrasound Endoscopy in the Differential Diagnosis of Cardiac Leiomyomas and Gastrointestinal Stromal Tumors
燊苏
Advances in Clinical Medicine.2023; 13(11): 17185. CrossRef
The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
Masanari Sekine, Takeharu Asano, Hirosato Mashima
Diagnostics.2022; 12(4): 810. CrossRef
Diagnostic accuracy of endoscopic ultrasound with artificial intelligence for gastrointestinal stromal tumors: A meta‐analysis
Xiao Hua Ye, Lin Lin Zhao, Lei Wang
Journal of Digestive Diseases.2022; 23(5-6): 253. CrossRef

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Case Report

Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria: Ah Lon Jung, Sang Wook Park, Gun Young Hong, Hyeong Chul Moon, Seo Joon Eun; Clin Endosc 2021;54(1):131-135. Published online August 21, 2020; DOI: https://doi.org/10.5946/ce.2020.070

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Most cases of gastric subepithelial lesions follow a good clinical course; however, some lesions progress to malignant tumors, and treatment of tumors with a high risk of malignancy is essential. Surgical excision has been the primary treatment for tumors originating from the propria muscle layer, but it has the disadvantages of being invasive and causing postoperative functional abnormalities. With the development of endoscopic techniques and instruments, the role of endoscopic resection, which is a less invasive method for the removal of gastric subepithelial lesions, has been attracting attention. We performed an endoscopic full-thickness resection for 8 patients with gastric subepithelial lesions originating from the muscularis propria. No fatal complications occurred. Our findings suggest the need to develop various devices for resection and closure and to accumulate further experience through additional studies to prevent complications and specimen loss.

Citations

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Robotic Platforms for Therapeutic Flexible Endoscopy: A Literature Review
Naoya Tada, Kazuki Sumiyama
Diagnostics.2024; 14(6): 595. CrossRef
Advances of endoscopic and surgical management in gastrointestinal stromal tumors
Lei Yue, Yingchao Sun, Xinjie Wang, Weiling Hu
Frontiers in Surgery.2023;[Epub] CrossRef
Current Status of Endoscopic Full-Thickness Resection for Gastric Subepithelial Tumors: A Literature Review Over Two Decades
Naoya Tada, Hideki Kobara, Noriko Nishiyama, Shintaro Fujihara, Tsutomu Masaki, Noriya Uedo
Digestion.2023; 104(6): 415. CrossRef
Endoscopic Full Thickness Resection: A Systematic Review
Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
Journal of Digestive Endoscopy.2022; 13(03): 152. CrossRef

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Original Article

Reasons for Diagnostic Failure in Forty-Five Consecutive Mucosal Cutting Biopsy Examinations of Gastric Subepithelial Tumors: Yoshiko Nakano, Toshitatsu Takao, Yoshinori Morita, Shinwa Tanaka, Takashi Toyonaga, Eiji Umegaki, Yuzo Kodama; Clin Endosc 2020;53(5):575-582. Published online February 14, 2020; DOI: https://doi.org/10.5946/ce.2019.150

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Background
/Aims: Mucosal cutting biopsy (MCB) is useful for the histopathological diagnosis of gastric subepithelial tumors (SETs). However, there is little information on cases in which MCB did not establish a diagnosis. In the current study, we aimed to investigate the characteristics of cases in which MCB was unsuccessful.
Methods
Cases in which MCB was used to histopathologically diagnose gastric SETs at Kobe University Hospital between August 2012 and October 2018 were retrospectively reviewed.
Results
Forty-five cases in which MCB was used to diagnose 43 gastric SETs in 43 patients were analyzed. The median tumor size was 20 mm (range, 8–50 mm). Pathological examinations resulted in definitive and suspected diagnoses and no diagnosis in 29 (gastrointestinal stromal tumor: n=17, leiomyoma: n=7, aberrant pancreas: n=3, others: n=2), 6, and 10 cases, respectively. Failure to expose the tumor according to retrospective examinations of endoscopic images was significantly associated with no diagnosis. Other possible explanations included a less elevated tumor, biopsy of the surrounding field instead of the tumor due to the mobility, and poor endoscope maneuverability due to the tumor being close to the cardia.
Conclusions
Clear exposure of gastric SETs during MCB may improve the diagnostic rate of such examinations.

Citations

Citations to this article as recorded by

Technical outcomes and postprocedural courses of mucosal incision‐assisted biopsy for possible gastric gastrointestinal stromal tumors: A series of 48 cases (with video)
Eriko Koizumi, Osamu Goto, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri
DEN Open.2024;[Epub] CrossRef
Utility and advantage of the unroofing technique for gastrointestinal subepithelial tumors: A multicenter retrospective cohort study
Masashi Yamamoto, Tsutomu Nishida, Ryotaro Uema, Takashi Kanesaka, Hiroyuki Ogawa, Shinji Kitamura, Hideki Iijima, Kengo Nagai, Shusaku Tsutsui, Masato Komori, Katsumi Yamamoto, Yoshiki Tsujii, Yoshito Hayashi, Tetsuo Takehara
DEN Open.2024;[Epub] CrossRef
Endoscopic ultrasound-guided bite-on-bite biopsy and endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of gastric tumors with negative malignant endoscopy biopsies: a retrospective cohort study
Liang Min, Yan Jin, Jiefei Chen, Hongyi Zhu, Chengbai Liang, Liang Lv, Yongjun Wang, Deliang Liu, Yuqian Zhou, Yi Chu, Yuyong Tan
Minimally Invasive Therapy & Allied Technologies.2024; : 1. CrossRef
Systematic Endoscopic Approach for Diagnosing Gastric Subepithelial Tumors
Gwang Ha Kim
Gut and Liver.2022; 16(1): 19. CrossRef
The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
Masanari Sekine, Takeharu Asano, Hirosato Mashima
Diagnostics.2022; 12(4): 810. CrossRef
Advancements in the Diagnosis of Gastric Subepithelial Tumors
Osamu Goto, Mitsuru Kaise, Katsuhiko Iwakiri
Gut and Liver.2022; 16(3): 321. CrossRef
Mucosal Incision-Assisted Endoscopic Biopsy as an Alternative to Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy for Gastric Subepithelial Tumor
Cheol Woong Choi, Joo Ha Hwang
Clinical Endoscopy.2020; 53(5): 505. CrossRef

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109 Download
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Case Report

Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal Tumors: Faisal Inayat, Aysha Aslam, Mathew D. Grunwald, Qulsoom Hussain, Abu Hurairah, Shahzad Iqbal; Clin Endosc 2019;52(3):283-287. Published online October 5, 2018; DOI: https://doi.org/10.5946/ce.2018.116

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arising from the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasingly detected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advanced technique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a number of methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem is appropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge, this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic option in patients with gastric GISTs.

Citations

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Endoscopic Full Thickness Resection: A Systematic Review
Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
Journal of Digestive Endoscopy.2022; 13(03): 152. CrossRef
Colon Sparing Endoscopic Full-Thickness Resection for Advanced Colorectal Lesions: Is It Time for Global Adoption?
Zhong-Wei Wu, Chao-Hui Ding, Yao-Dong Song, Zong-Chao Cui, Xiu-Qian Bi, Bo Cheng
Frontiers in Oncology.2022;[Epub] CrossRef
Endoscopic Therapy in the Management of Patients With Severe Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy: A Case-Based Systematic Review
Adnan Malik, Rizwan Ishtiaq, Muhammad Hassan Naeem Goraya, Faisal Inayat, Vinaya V. Gaduputi
Journal of Investigative Medicine High Impact Case Reports.2021; 9: 232470962110132. CrossRef
Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era
Antonino Granata, Alberto Martino, Dario Ligresti, Francesco Paolo Zito, Michele Amata, Giovanni Lombardi, Mario Traina
World Journal of Gastrointestinal Surgery.2021; 13(7): 645. CrossRef
Use of omental patch and endoscopic closure technique as an alternative to surgery after endoscopic full thickness resection of gastric intestinal stromal tumors: A series of cases
Amit H Sachdev, Shahzad Iqbal, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura
World Journal of Clinical Cases.2020; 8(1): 120. CrossRef
Endoscopic full-thickness resection
David Friedel, Xiaocen Zhang, Rani Modayil, Stavros N. Stavropoulos
Techniques in Gastrointestinal Endoscopy.2019; 21(1): 19. CrossRef

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Focused Review Series: Expanding the Indication with Safety Issue of Endoscopic Ultrasound

Contrast Enhanced Harmonic Endoscopic Ultrasound: A Novel Approach for Diagnosis and Management of Gastrointestinal Stromal Tumors: Ankit Chhoda, Deepanshu Jain, Venkateswar R Surabhi, Shashideep Singhal; Clin Endosc 2018;51(3):215-221. Published online May 31, 2018; DOI: https://doi.org/10.5946/ce.2017.170

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The histologic analysis of gastrointestinal stromal tumors (GISTs) is a common method to detect the mitotic activity and to subsequently determine the risk of GISTs for malignancy. The potential false negative error due to inadequate yield of specimens and actual determination of malignancy risk requires analysis of the whole tumor. We aimed to assess the role of contrast enhanced endoscopic ultrasound (CE-EUS) in the management of GISTs. Two authors individually did review of English literatures to identify nine peer-reviewed original articles using keywords- contrast endoscopic ultrasound, GIST and submucosal tumor. Studies were heterogeneous in their aims looking either at differentiating submucosal lesions from GISTs, estimating malignant potential of GISTs with histologic correlation or studying the role of angiogenesis in malignant risk stratification. CE-EUS had moderate to high efficacy in differentiating GISTs from alternative submucosal tumors. CE-EUS had a higher sensitivity than EUS-guided fine needle aspiration, contrast computed tomography and Doppler EUS for detection of neo-vascularity within the GISTs. However, the evidence of abnormal angiogenesis within GIST as a prognostic factor needs further validation. CE-EUS is a non-invasive modality, which can help differentiate GISTs and provide valuable assessment of their perfusion patterns to allow better prediction of their malignant potential but more experience is needed.

Citations

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Gastrointestinal Stromal Tumors (GISTs) in Pediatric Patients: A Case Report and Literature Review
Tudor-Alexandru Popoiu, Cãtãlin-Alexandru Pîrvu, Cãlin-Marius Popoiu, Emil Radu Iacob, Tamas Talpai, Amalia Voinea, Rãzvan-Sorin Albu, Sorina Tãban, Larisa-Mihaela Bãlãnoiu, Stelian Pantea
Children.2024; 11(9): 1040. CrossRef
The value of contrast-enhanced harmonic endoscopic ultrasound in differential diagnosis and evaluation of malignant risk of gastrointestinal stromal tumors (<50mm)
Jiali Wu, Mengqi Zhuang, Yubao Zhou, Xiang Zhan, Weiwei Xie
Scandinavian Journal of Gastroenterology.2023; 58(5): 542. CrossRef
Angiogenesis in gastrointestinal stromal tumors: From bench to bedside
Stavros P Papadakos, Christos Tsagkaris, Marios Papadakis, Andreas S Papazoglou, Dimitrios V Moysidis, Constantinos G Zografos, Stamatios Theocharis
World Journal of Gastrointestinal Oncology.2022; 14(8): 1469. CrossRef
Diagnostic accuracy of endoscopic ultrasound with artificial intelligence for gastrointestinal stromal tumors: A meta‐analysis
Xiao Hua Ye, Lin Lin Zhao, Lei Wang
Journal of Digestive Diseases.2022; 23(5-6): 253. CrossRef
Controversies in EUS: Do we need miniprobes?
Hans Seifert, Pietro Fusaroli, PaoloGiorgio Arcidiacono, Barbara Braden, Felix Herth, Michael Hocke, Alberto Larghi, Bertrand Napoleon, Mihai Rimbas, BogdanSilvio Ungureanu, Adrian Sãftoiu, AnandV Sahai, ChristophF Dietrich
Endoscopic Ultrasound.2021; 10(4): 246. CrossRef
Convolutional neural network‐based object detection model to identify gastrointestinal stromal tumors in endoscopic ultrasound images
Chang Kyo Oh, Taewan Kim, Yu Kyung Cho, Dae Young Cheung, Bo‐In Lee, Young‐Seok Cho, Jin Il Kim, Myung‐Gyu Choi, Han Hee Lee, Seungchul Lee
Journal of Gastroenterology and Hepatology.2021; 36(12): 3387. CrossRef
Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: a systematic review and meta-analysis
Yong-tao Yang, Neng Shen, Fei Ao, Wei-qing Chen
Surgical Endoscopy.2020; 34(9): 3754. CrossRef
Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract
Cicilia Marcella, Shakeel Sarwar, Hui Ye, Rui Hua Shi
Clinical Endoscopy.2020; 53(4): 458. CrossRef
Predicting Malignancy Risk in Gastrointestinal Subepithelial Tumors with Contrast-Enhanced Harmonic Endoscopic Ultrasonography Using Perfusion Analysis Software
Hyun Seok Lee, Chang Min Cho, Yong Hwan Kwon, Su Youn Nam
Gut and Liver.2019; 13(2): 161. CrossRef
Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors
Takashi Tamura, Masayuki Kitano
Clinical Endoscopy.2019; 52(4): 306. CrossRef

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Original Article

Non-Exposure Endoscopic-Laparoscopic Cooperative Surgery for Stomach Tumors: First Experience from the Czech Republic: Jan Hajer, Lukáš Havlůj, Adam Whitley, Robert Gürlich; Clin Endosc 2018;51(2):167-173. Published online January 4, 2018; DOI: https://doi.org/10.5946/ce.2017.076

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to investigate the use of non-exposure endoscopic wall-inversion surgery (NEWS) and the combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) in gastric tumors.
Methods
We reviewed all cases of NEWS and CLEAN-NET performed in the department of surgery of the Royal Vinohrady Teaching Hospital.
Results
Our department performed 12 gastric tumor resections (NEWS, n=10 and CLEAN-NET, n=2) between March 2016 and February 2017. The cases chosen for these resections included predominantly submucosal tumors with no signs of dissemination or local invasion and early gastric carcinomas (T1_SM1 and T1_M), where tumor location made it impossible to use endoscopic submucosal dissection. R0 resection margins were confirmed in all the cases.
Conclusions
NEWS and CLEAN-NET allow en bloc non-exposed full-thickness gastric wall resection in a way that uses a “close first, cut later” approach to prevent seeding of the peritoneal cavity with tumor cells. These mini-invasive techniques combine laparoscopic and endoscopic techniques, and preserve the full function of the stomach.

Citations

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Pure endoscopic resection versus laparoscopic assisted procedure for upper gastrointestinal stromal tumors: Perspective from a surgical endoscopist
Hon Chi Yip, Jun Liang Teh, Anthony Y. B. Teoh, Philip Chiu
Digestive Endoscopy.2023; 35(2): 184. CrossRef
Advances of endoscopic and surgical management in gastrointestinal stromal tumors
Lei Yue, Yingchao Sun, Xinjie Wang, Weiling Hu
Frontiers in Surgery.2023;[Epub] CrossRef
Laparoscopic and endoscopic cooperative surgery for early gastric cancer: Perspective for actual practice
Peng-yue Zhao, Zhao-fu Ma, Ya-nan Jiao, Yang Yan, Song-yan Li, Xiao-hui Du
Frontiers in Oncology.2022;[Epub] CrossRef
The techniques of hybrid laparo-endoscopic resections for non-epithelial gastric tumors
S.V. Dzhantukhanova, Yu.G. Starkov, R.D. Zamolodchikov, A.A. Zvereva, P.K. Kontorshchikov
Endoskopicheskaya khirurgiya.2021; 27(4): 47. CrossRef
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Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
Clinical Endoscopy.2021; 54(5): 633. CrossRef
CLEAN-NET: a modified laparoendoscopic wedge resection of the stomach to minimize the sacrifice of innocent gastric wall
Eiji Kanehira, Aya Kamei Kanehira, Takashi Tanida, Kodai Takahashi, Yuichi Obana, Kazunori Sasaki
Surgical Endoscopy.2020; 34(1): 290. CrossRef
Clinical outcomes of non-exposed endoscopic wall-inversion surgery for gastric submucosal tumors: long-term follow-up and functional results
Junya Aoyama, Osamu Goto, Hirofumi Kawakubo, Shuhei Mayanagi, Kazumasa Fukuda, Tomoyuki Irino, Rieko Nakamura, Norihito Wada, Hiroya Takeuchi, Naohisa Yahagi, Yuko Kitagawa
Gastric Cancer.2020; 23(1): 154. CrossRef
Comparison of Nonexposed Endoscopic Wall-Inversion Surgery with Endoscopic-Navigated Laparoscopic Wedge Resection for Gastric Submucosal Tumours: Results of a Two-Centre Study
Jan Hajer, Lukáš Havlůj, Petr Kocián, Günther Klimbacher, Andreas Shamiyeh, Robert Gürlich, Adam Whitley
Gastroenterology Research and Practice.2019; 2019: 1. CrossRef
Clinical Overview of GIST and Its Latest Management by Endoscopic Resection in Upper GI: A Literature Review
Cicilia Marcella, Rui Hua Shi, Shakeel Sarwar
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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Focused Review Series: Advanceses in the management of upper GI SET

Current Techniques for Treating Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract: Weon Jin Ko, Joo Young Cho; Clin Endosc 2016;49(3):226-228. Published online May 23, 2016; DOI: https://doi.org/10.5946/ce.2016.061

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Most gastrointestinal stromal tumors (GISTs) arise from the proper muscle layer of the upper gastrointestinal (GI) tract and have a low malignant potential. They are sometimes accompanied by symptoms, but in most cases are detected by chance. Endoscopic surgery of subepithelial tumors in the upper GI tract has been actively performed, and its merits include the need for fewer medical devices compared with other surgical procedures and post-resection organ preservation. However, because endoscopic procedures are still limited to small or pilot studies, a multidisciplinary approach combining laparoscopy and endoscopy is needed for more effective and pathologically acceptable management of GISTs. Many new endoscopic surgeries have been developed, and this review describes the current status of and the new approaches for endoscopic surgery of GISTs in the upper GI tract.

Citations

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Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea
Yuri Kim, Ji Yong Ahn, Hwoon-Yong Jung, Seokin Kang, Ho June Song, Kee Don Choi, Do Hoon Kim, Jeong Hoon Lee, Hee Kyong Na, Young Soo Park
Clinical Endoscopy.2024; 57(3): 350. CrossRef
New data on the types of sulfide copper-nickel ores of the Kharaelakh trough and the main patterns of their distribution
I. O. Krylov, I. I. Nikulin
Moscow University Bulletin. Series 4. Geology.2023; (3): 98. CrossRef
Advances in endoscopic resection techniques of small gastric tumors originating from the muscularis propria
Suliman Khan, Xiaona Cui, Safyan Nasir, Shoaib Mohammad Rafiq, Bo Qin, Qian Bai
Frontiers in Oncology.2022;[Epub] CrossRef
New data on the composition of plagioclase on the western flank of the Oktyabrsky deposit according to infrared spectroscopy
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Long-Term Outcomes after Endoscopic Treatment of Gastric Gastrointestinal Stromal Tumor: Jong-Jae Park; Clin Endosc 2016;49(3):232-234. Published online May 19, 2016; DOI: https://doi.org/10.5946/ce.2016.052

Abstract PDF PubReader ePub

Endoscopic resection of gastric subepithelial tumors (SETs) has several advantages over biopsy techniques, such as superior diagnostic yield and definite diagnosis. Removal of gastric SETs and histopathologic confirmation should be considered whenever gastric SETs are highly suspected to have malignant potential such as gastrointestinal stromal tumor (GIST) or neuroendocrine tumor. According to our clinical experience, we suggest that endoscopic resection of gastric SETs is feasible for GISTs less than 3.0 cm without positive endoscopic ultrasonography findings or for hypoechoic SETs less than 3.0 cm. However, serious complications such as macroperforation may occur during endoscopic resection, and this procedure is highly dependent on endoscopists’ skills. We recently reported the long-term clinical outcomes of endoscopic resection of gastric GIST, which showed a relatively low recurrence rate (2.2%) during long-term follow-up (46.0±28.5 months) despite the low R0 resection rate (25.0%). We suggest that endoscopic surveillance might be possible without additional surgical resection in completely resected GISTs without residual tumor confirmed to be lower risk, even if they show an R1 resection margin.

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Interpretation of Pathologic Margin after Endoscopic Resection of Gastrointestinal Stromal Tumor: Sang Gyun Kim; Clin Endosc 2016;49(3):229-231. Published online April 7, 2016; DOI: https://doi.org/10.5946/ce.2016.035

Abstract PDF PubReader ePub

Interpretation of the pathologic margin of a specimen from a resected tumor is important because local recurrence can be predicted by the presence of tumor cells in the resection margin. Although a sufficient resection margin is recommended in the resection of gastrointestinal adenocarcinoma, it is not usually regarded strictly in cases of mesenchymal tumor, especially gastrointestinal stromal tumor (GIST), because the tumor is usually encapsulated or well demarcated, and not infiltrative. Therefore, margin positivity is not rare in the pathological evaluation of surgically or endoscopically resected GIST, and does not always indicate incomplete resection. Although a GIST may have a tumor-positive pathologic margin, complete resection may be achieved if no residual tumor is visible, and long-term survival can be predicted as in the cases with a negative pathologic margin.

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Fabrice Caillol, Elise Meunier, Christophe Zemmour, Jean-Philippe Ratone, Jerome Guiramand, Solene Hoibian, Yanis Dahel, Flora Poizat, Marc Giovannini
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Case Report

Non-Exposed Endoscopic Wall-Inversion Surgery for Gastrointestinal Stromal Tumor of the Stomach: First Case Report in Korea: Da Won Kim, Joon Sung Kim, Byung-Wook Kim, Ji Yun Jung, Gi Jun Kim, Jin-Jo Kim; Clin Endosc 2016;49(5):475-478. Published online March 15, 2016; DOI: https://doi.org/10.5946/ce.2016.002

Abstract PDF PubReader ePub

Laparoscopic wedge resection of the stomach is a widely accepted treatment for primary resectable gastrointestinal stromal tumors (GISTs). However, it is difficult to determine the appropriate incision line from outside of the stomach, and many attempts have been made to avoid unnecessary resection of unaffected gastric tissues. Recently a technique called non-exposed endoscopic wall-inversion surgery (NEWS) was introduced to avoid exposure of GIST to the peritoneum. Here, we describe the first published case of NEWS for GIST of the stomach practiced in Korea.

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Focused Review Series: Advances in the management of upper GI SET

Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors: Jin Woong Cho, the Korean ESD Study Group; Clin Endosc 2016;49(3):235-240. Published online February 22, 2016; DOI: https://doi.org/10.5946/ce.2015.096

Abstract PDF PubReader ePub

Subepithelial tumors are frequently found in asymptomatic patients in Japan and Korea where cancer screening tests routinely include endoscopy. Most lesions are asymptomatic and clinically insignificant. However, carcinoid tumors, lymphomas, glomus tumor and gastrointestinal stromal tumors (GISTs) are malignant or have the potential to become malignant. Inflammation due to parasitic infestation by Anisakis and poorly differentiated adenocarcinomas in the stomach rarely present as subepithelial lesions. In contrast to the frequency of gastric GIST in the gastrointestinal system, they are uncommon in the duodenum and very rare in the esophagus. The prognosis of patients with GISTs in the stomach is relatively good compared with GISTs in other organs. Along with the location of the tumor, its size and mitotic count are major factors that determine the malignant potential of GIST. Small (<2 cm) asymptomatic GISTs usually have benign clinical course. GIST is the most common subepithelial tumor to occur in the stomach. Although various methods are employed to diagnose GISTs, the risk of GIST metastasis cannot be accurately predicted before lesions are completely resected. Recently, new endoscopic diagnostic methods and treatment techniques have been developed that allow the diagnosis and resection of lesions located in the muscularis propria, without any complications. These endoscopic methods have different indications depending on regions where they are performed.

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Case Report

Signet-Ring Cell Carcinoma Mimicking Gastric Gastrointestinal Stromal Tumor Confirmed by Endoscopic Ultrasound-Guided Trucut Biopsy: Seong Hun Kim, Soo Teik Lee, Byung Jun Jeon, In Hee Kim, Sang Wook Kim, Seung Ok Lee, Dae Ghon Kim, Ho Sung Park; Clin Endosc 2012;45(4):421-424. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.421

Abstract PDF PubReader ePub

A submucosal gastric adenocarcinoma, especially the signet ring cell type, is rare. The histologic evaluation techniques for this lesion has not been established; however, histologic confirmation is very important for decision of treatment method. Here, we report a 57-year-old man with a 12-cm gastric submucosal signet ring cell type adenocarcinoma, diagnosed by an endoscopic ultrasound-guided Trucut biopsy and immunochemical studies. This case suggests that the endoscopic ultrasound-guided Trucut biopsy might be a useful diagnostic method in cases of gastric adenocarcinoma with features of gastrointestinal stromal tumor.

Citations

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Subepithelial Tumor-like Gastric Cancer
Kyoungwon Jung, Moo In Park
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(2): 106. CrossRef
Presentation of signet ring cell type at carcinoma ventriculi of the patient aged 20 years old
Afrim Avdaj, Ugur Gozalan, Nexhmi Hyseni, Hatim Baxhaku, Sherif Krasniqi, Shpejtim Rramanaj
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Focused Review Series: What Should We Know about EUS-FNA?

Endoscopic Ultrasound-Guided Fine Needle Aspiration in Submucosal Lesion: Jeong Seop Moon; Clin Endosc 2012;45(2):117-123. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.117

Abstract PDF PubReader ePub

A submucosal lesion, more appropriately a subepithelial lesion, is hard to diagnose. Endoscopic ultrasonography is good to differentiate the nature of submucosal lesion. For definite diagnosis, tissue acquisition from submucosal lesion is necessary, and many methods have been introduced for this purpose mainly by endoscopic ultrasonography, such as endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), EUS-guided Trucut Biopsy (TCB), and EUS-guided fine needle biopsy (FNB). For EUS-FNA, adequate processing of specimen is important, and for proper diagnosis of EUS-FNA specimen, both cytologic and histologic examinations, including immunohistochemical stains, are important. All gastrointestinal stromal tumors have some degree of malignant potential, so there have been a lot of efforts and methods to increase diagnostic yields of submucosal lesion. We herein review the current hot topics on EUS-FNA for submucosal tumor, such as needles, on-site cytopathologists, immunohistochemical stains, EUS-TCB, EUS-FNB, Ki-67 labelling index, DOG1, and combining EUS-FNA and EUS-TCB.

Citations

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A Case of a Duodenal Gastrointestinal Stromal Tumor with a Bleeding Ulcer: Hyuk Jin Kwon, M.D., Hyeon Geun Cho, M.D., Myong Hwan Kim, M.D., Geun Jun Ko, M.D., Jin Ho Jeong, M.D.* and Ji Sun Song, M.D.^†; Korean J Gastrointest Endosc 2009;39(1):42-45. Published online July 30, 2009

Abstract PDF: Duodenal gastrointestinal stromal tumors (GISTs) are relatively rare tumors that commonly present with gastrointestinal bleeding. Evaluation with endoscopic ultrasonography (EUS) is a useful technique for the differential diagnosis of GISTs from other submucosal tumors. A 58-year-old man presented with melena and anemia. An esophago-gastroduodenoscopy showed the presence of a submucosal tumor in the second portion of the duodenum with central ulceration and a flat spot. EUS showed the presence of a suspicious malignant GIST that originated from the proper muscle layer, which was successfully resected. We report a case of a duodenal GIST with a bleeding ulcer. Positive reactivity for CD117 and S-100 was demonstrated by immunohistochemical staining. (Korean J Gastrointest Endosc 2009;39:42-45)

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A Case of Incidentally Found Esophageal Gastrointestinal Stromal Tumor: Jee Suk Lee, M.D., Moo In Park, M.D., Seun Ja Park, M.D., Kyu Jong Kim, M.D., Won Moon, M.D., Sung Woo Yang, M.D., Hong Jun You, M.D. and Bong Kwon Chun, M.D.*; Korean J Gastrointest Endosc 2007;35(1):23-27. Published online July 30, 2007

Abstract PDF: There are few reports of gastrointestinal stromal tumors (GISTs) in the esophagus. The authors report a patient with an esophageal GIST that was found incidentally during an endoscopy. The endoscopy revealed a 1 cm sized mass with a granular surface at the 32 cm site from the upper incisor. Endoscopic ultrasonography revealed the tumor to be located in the muscularis mucosa of the esophageal wall. Histologically, the tumor consisted of spindle cells, with no mitotic index, that were immunoreactive for KIT and S-100. The tumor was diagnosed as a gastrointestinal stromal tumor with neural differentiation (GINT). An endoscopic mucosal resection was performed and the patient has been on routine follow up at the out patient department for three months.

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Hemoperitoneum Induced by Gastrointestinal Stromal Tumor Rupture of the Stomach: Eun Young Cho, M.D., Mi Ryeong Sim, M.D., Sang Jae Rhee, M.D., Hee Sik Kim, M.D., Joo Jin Yeom, M.D., Yong Sung Kim, M.D., Sang Wook Kim, M.D., Geom Suck Seo, M.D., Young Woo Son, M.D., Tae Hyeon Kim, M.D., Suck Chei Choi, M.D., Eun A Kim, M.D.*, Yong Ho; Korean J Gastrointest Endosc 2003;27(4):220-224. Published online October 31, 2003

Abstract PDF: Gastrointestinal stromal tumors (GIST) form a group of uncommon neoplasms originated from the pleuripotential mesenchymal cell. There is no final conclusion about accurate diagnosis and prognostic factors of GIST. Clinical presentation is not specific and intraperitoneal bleeding is a very rare complication. We report a case of a malignant GIST complicated by intraperitoneal hemorrhage, which was diagnosed by abdominal CT and EUS before operation. A subtotal gastrectomy was perfomed without complication. The patient is still alive without recurrence.

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