Endoscopic Full-thickness Resection for Gastric Submucosal Tumor: A Technical Analysis Study (With Video)

Area of Science:

• Gastroenterology
• Surgical Endoscopy
• Oncology

Background:

• Endoscopic full-thickness resection (EFTR) is a key treatment for gastric submucosal tumors (SMTs).
• Technical analysis and outcome comparison of EFTR for gastric SMTs were performed.
• Sixty-one gastric SMTs from 60 patients were analyzed.

Purpose of the Study:

• To conduct a technical analysis of EFTR for gastric SMTs.
• To compare EFTR outcomes with established parameters.
• To evaluate the impact of technical improvements on EFTR efficacy.

Main Methods:

• EFTR was performed on gastric SMTs meeting specific criteria (size, location, histology).
• Technical advancements included clip-line traction, plastic bag retriever, reopenable clip over-the-line method (ROLM), no-touch EFTR, and elimination of submucosal injection.
• Study divided into three periods to implement and assess these improvements sequentially.

Main Results:

• Achieved 100% endoscopic complete resection rate with consistent tumor resection time (median 50 min).
• Plastic bag retriever reduced specimen damage (p=0.001).
• No-touch EFTR in Period 3 increased specimen size (33 mm, p=0.010) and improved GIST R0 resection rate (100%, p=0.017).

Conclusions:

• Several technical improvements significantly enhance EFTR outcomes for gastric SMTs.
• The study demonstrates the efficacy and safety of refined EFTR techniques.
• External validation of these improved EFTR techniques is warranted.