BACKGROUND The spectrum of gastric submucosal tumors(SMTs)in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions,with gastrointestinal stromal tumors exhibiting inherent malignant potenti...BACKGROUND The spectrum of gastric submucosal tumors(SMTs)in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions,with gastrointestinal stromal tumors exhibiting inherent malignant potential.However,the diagnosis of SMTs remains challenging,and treatment methods,especially for tumors located at the cardia or esophagogastric junction(EGJ),are not well established.Minimally invasive techniques-such as endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER),and laparoscopic wedge resection(LWR)-have been developed for these lesions.However,comparative data on their feasibility,safety,and clinical outcomes in these locations remain limited.AIM To compare ESD,STER,and LWR for SMTs at the EGJ or cardia,focusing on procedural feasibility.METHODS This single-center retrospective study included patients with SMTs less than 45 mm from the muscularis propria,growing intraluminally at the EGJ or cardia,and treated with ESD,STER,or LWR between July 2014 and September 2022.The primary outcome was relapse-free survival during follow-up.RESULTS The median age(interquartile range)was 53.0(40.0-57.5),43.0(39.0-57.0),and 56.0(43.0-64.0)years for ESD,STER,and LWR,respectively.The median follow-up time(interquartile range)was 60.0(26.5-66.5),24.0(13.0-38.0),and 35.0(21.0-60.0)months.LWR had the largest tumors(30.0 mm)and the highest rate of high-risk gastrointestinal stromal tumors(68.0%,P<0.001).Tumor recurrence occurred in one LWR patient(4.0%,P=0.600).En bloc and macroscopic resection rates were 100%(P=1.000),but microscopic resection rates differed(P=0.021).Significant minor complications occurred in 5 patients(10.0%),all grade IIIa.Tumor location(cardia/fundus,P=0.006)and prolonged procedure time(P<0.001)were significantly associated with complications.CONCLUSION ESD,STER,and LWR are effective for SMTs at the EGJ and cardia,with minor complications associated with tumor location and procedure time,and comparable recurrence rates.展开更多
BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resectio...BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs.AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection(ESMR-L)following unroofing technique for small esophageal SEL-MPs.METHODS From January 2021 to September 2023,17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People’s Hospital.Details of clinicopathological characteristics and clinical outcomes were collected and analyzed.RESULTS The mean age of the patients was 50.12±12.65 years.The mean size of the tumors was 7.47±2.83 mm and all cases achieved en bloc resection successfully.The average operation time was 12.2 minutes without any complications.Histopathology identified 2 Lesions(11.8%)as gastrointestinal stromal tumors at very low risk,12 Lesions(70.6%)as leiomyoma and 3 Lesions(17.6%)as smooth muscle proliferation.No recurrence was found during the mean follow-up duration of 14.18±9.62 months.CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm,but it cannot ensure en bloc resection and may require further treatment.展开更多
AIM:To explore endoscopic therapy methods for gastric stromal tumors originating from the muscularis propria.METHODS:For 69 cases diagnosed as gastric stromal tumors originating from the muscularis propria,three types...AIM:To explore endoscopic therapy methods for gastric stromal tumors originating from the muscularis propria.METHODS:For 69 cases diagnosed as gastric stromal tumors originating from the muscularis propria,three types of endoscopic therapy were selected,based on the size of the tumor.These methods included endoscopic ligation and resection(ELR),endoscopic submucosal excavation(ESE) and endoscopic full-thickness resection(EFR).The wound surface and the perforation of the gastric wall were closed with metal clips.Immunohistostaining for CD34,CD117,Dog-1,S-100 and smooth muscle actin(SMA) was performed on the resected tumors.RESULTS:A total of 38 cases in which the tumor size was less than 1.2 cm were treated with ELR;three cases were complicated by perforation,and the perforations were closed with metal clips.Additionally,18 cases in which the tumor size was more than 1.5 cm were treated with ESE,and no perforation occurred.Finally,13 cases in which the tumor size was more than 2.0 cm were treated with EFR;all of the cases were complicated by artificial perforation,and all of the perforations were closed with metal clips.All of the 69 cases recovered with medical treatment,and none required surgical operation.Immunohistostaining demonstrated that among all of the 69 gastric stromal tumors diagnosed by gastroscopy,12 cases were gastric leiomyomas(SMA-positive),and the other 57 cases were gastric stromal tumors.CONCLUSION:Gastric stromal tumors originating from the muscularis propria can be treated successfully with endoscopic techniques,which could replace certain surgical operations and should be considered for further application.展开更多
AIM: To evaluate the efficacy, safety and feasibility of endoscopic full-thickness resection (EFR) for the treatment of gastric submucosal tumors (SMTs) arising from the muscularis propria.
AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria(SMTMPs).METHODS By reviewing the computerized medical records over a period of 14 years(2000-2013), patient...AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria(SMTMPs).METHODS By reviewing the computerized medical records over a period of 14 years(2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound(EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in 2016.RESULTS A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors(GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until 2016.CONCLUSION Most 1-3 cm gastric SMTMPs(71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size(> 14.0 mm) and irregular border.展开更多
Visceral myopathy is one of the causes of chronic intestinal pseudo-obstruction. Most cases pathologically reveal degenerative changes of myocytes or muscularis propia atrophy and fibrosis. Abnormal layering of muscul...Visceral myopathy is one of the causes of chronic intestinal pseudo-obstruction. Most cases pathologically reveal degenerative changes of myocytes or muscularis propia atrophy and fibrosis. Abnormal layering of muscularis propria is extremely rare. We report a case of a 9-mo-old Thai male baby who presented with chronic intestinal pseudo-obstruction. Histologic findings showed abnormal layering of small intestinal muscularis propria with an additional oblique layer and aberrant muscularization in serosa. The patient also had a short small bowel without malrotation, brachydactyly,and absence of the 2nd to 4th middle phalanges of both hands. The patient was treated with cisapride and combined parenteral and enteral nutritional support.He had gradual clinical improvement and gained body weight. Subsequently, the parenteral nutrition was discontinued. The previously reported cases are reviewed and discussed.展开更多
BACKGROUND Endoscopic resection approaches,including endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER)and endoscopic fullthickness resection(EFTR),have been widely used for the trea...BACKGROUND Endoscopic resection approaches,including endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER)and endoscopic fullthickness resection(EFTR),have been widely used for the treatment of submucosal tumors(SMTs)located in the upper gastrointestinal tract.However,compared to SMTs located in the esophagus or stomach,endoscopic resection of SMTs from the esophagogastric junction(EGJ)is much more difficult because of the sharp angle and narrow lumen of the EGJ.SMTs originating from the muscularis propria(MP)in the EGJ,especially those that grow extraluminally and adhere closely to the serosa,make endoscopic resection even more difficult.AIM To investigate the predictors of difficult endoscopic resection for SMTs from the MP layer at the EGJ.METHODS A total of 90 patients with SMTs from the MP layer at the EGJ were included in the present study.The difficulty of endoscopic resection was defined as a long procedure time,failure of en bloc resection and intraoperative bleeding.Clinicopathological,endoscopic and follow-up data were collected and analyzed.Statistical analysis of independent risks for piecemeal resection,long operative time,and intraoperative bleeding were assessed using univariate and multivariate analyses.RESULTS According to the location and growth pattern of the tumor,44 patients underwent STER,14 patients underwent EFTR,and the remaining 32 patients received a standard ESD procedure.The tumor size was 20.0 mm(range 5.0–100.0 mm).Fourty-seven out of 90 lesions(52.2%)were regularly shaped.The overall en bloc resection rate was 84.4%.The operation time was 43 min(range 16–126 min).The intraoperative bleeding rate was 18.9%.There were no adverse events that required therapeutic intervention during or after the procedures.The surgical approach had no significant correlation with en bloc resection,long operative time or intraoperative bleeding.Large tumor size(≥30 mm)and irregular tumor shape were independent predictors for piecemeal resection(OR:7.346,P=0.032 and OR:18.004,P=0.029,respectively),long operative time(≥60 min)(OR:47.330,P=0.000 and OR:6.863,P=0.034,respectively)and intraoperative bleeding(OR:20.631,P=0.002 and OR:19.020,P=0.021,respectively).CONCLUSION Endoscopic resection is an effective treatment for SMTs in the MP layer at the EGJ.Tumors with large size and irregular shape were independent predictors for difficult endoscopic resection.展开更多
Background： Gastric stromal tumors arising from the muscularis propria are located in deeper layers. Endoscopic resection may be contraindicated due to the possibility of perforation. These tumors are therefore usual...Background： Gastric stromal tumors arising from the muscularis propria are located in deeper layers. Endoscopic resection may be contraindicated due to the possibility of perforation. These tumors are therefore usually removed by surgical or laparoscopic procedures. This study evaluated the curative effects, safety and feasibility of endoscopic full-thickness resection （EFR） of gastric stromal tumors originating from the muscularis propria. Methods： This study enrolled 92 patients with gastric stromal tumors 〉2.5 cm originating from the muscularis propria. Fifty patients underwent EFR, and 42 underwent laparoscopic intragastric surgery. Operation time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared in these two groups. Results： EFR resulted in complete resection of all 50 gastric stromal tumors, with a mean procedure time of 85± 20 min, a mean hospitalization time of 7.0± 1.5 days and no complications. Laparoscopic intragastric surgery also resulted in a 100% complete resection rate, with a mean operation time of 88 ± 12 min and a mean hospitalization period of 7.5 ± 1.6 days. The two groups did not differ significantly in operation time, complete resection rates, hospital stay or incidence of complications （P 〉 0.05）. No patient in either group experienced tumor recurrence. Conclusions： EFR technique is effective and safe for the resection of gastric stromal tumors arising from the muscularis propria.展开更多
Background Gastric stromal tumors are the most common type of tumor originating from mesenchymal tissue. The traditional method for the treatment of gastric stromal tumor is surgical operation or therapeutic laparosco...Background Gastric stromal tumors are the most common type of tumor originating from mesenchymal tissue. The traditional method for the treatment of gastric stromal tumor is surgical operation or therapeutic laparoscopy. More recently, endoscopic micro-traumatic surgery has become possible for gastric stromal tumors, with any perforation caused by endoscopic therapy mended endoscopically. We assessed the effectiveness of endoscopic full-thickness resection （EFR） in the treatment of gastric stromal tumors arising from the muscularis propria. Methods Of the 42 gastric stromal tumors, each 〉2.0 cm in diameter, arising from the muscularis propria, 22 were removed by EFR and 20 by laparoscopic surgery. Tumor expression of CD34, CDl17, Dog-l, S-100, and smooth muscle actin （SMA） was assessed immunohistochemically. Operating time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared between the two groups. Continuous data were compared by using independent samples t-tests and categorical data by using Xz tests. Results Comparisons of the 22 gastric stromal tumors treated with EFR and the 20 treated with laparoscopic surgery showed similar operation times （60-155 minutes （mean, （90±17） minutes） vs. 50-210 minutes （mean, （95±21） minutes）, P 〉0.05）, complete resection rates （100% vs. 95%, P 〉0.05）, and length of hospital stay （4-10 days （mean, （6.0±1.8） days） vs. 4-12 days （mean, （7.3±1.7） days）, P 〉0.05）. None of the patients treated with EFR experienced complications, whereas one patient treated with laparoscopy required a conversion to laparotomy and one experienced postoperative gastroparesis. No recurrences were observed in either group. stromal tumors diagnosed by gastroscopy and endoscopic remaining 36 were stromal tumors. mmunohistochemical staining showed that of the 42 gastric ultrasound, six were leiomyomas （SMA-positive） and the Conclusions Gastric stromal tumors arising from the muscularis propria can be completely removed by EFR. EFR may replace surcjical or laparoscopic procedures for the removal of gastric stromal tumors.展开更多
INTRODUCTION Gastric stromal tumor （GST） is a set of gastrointestinal mesenchymal tumors those originate from interstitial cells of Cajal. Its early diagnosis and treatment are critical to prognosis. The occurrence ...INTRODUCTION Gastric stromal tumor （GST） is a set of gastrointestinal mesenchymal tumors those originate from interstitial cells of Cajal. Its early diagnosis and treatment are critical to prognosis. The occurrence of GST remains obscure; this study used Affymetrix expression spectrum chip to detect the gene expression spectrum of GST and explore new molecular target that is used in the treatment and prognosis of GST.展开更多
For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions ori...For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.展开更多
AIM: To assess the effectiveness of endoscopic full-thickness resection (EFR) and laparoscopic surgery in the treatment of gastric stromal tumors arising from the muscularis propria.
文摘BACKGROUND The spectrum of gastric submucosal tumors(SMTs)in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions,with gastrointestinal stromal tumors exhibiting inherent malignant potential.However,the diagnosis of SMTs remains challenging,and treatment methods,especially for tumors located at the cardia or esophagogastric junction(EGJ),are not well established.Minimally invasive techniques-such as endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER),and laparoscopic wedge resection(LWR)-have been developed for these lesions.However,comparative data on their feasibility,safety,and clinical outcomes in these locations remain limited.AIM To compare ESD,STER,and LWR for SMTs at the EGJ or cardia,focusing on procedural feasibility.METHODS This single-center retrospective study included patients with SMTs less than 45 mm from the muscularis propria,growing intraluminally at the EGJ or cardia,and treated with ESD,STER,or LWR between July 2014 and September 2022.The primary outcome was relapse-free survival during follow-up.RESULTS The median age(interquartile range)was 53.0(40.0-57.5),43.0(39.0-57.0),and 56.0(43.0-64.0)years for ESD,STER,and LWR,respectively.The median follow-up time(interquartile range)was 60.0(26.5-66.5),24.0(13.0-38.0),and 35.0(21.0-60.0)months.LWR had the largest tumors(30.0 mm)and the highest rate of high-risk gastrointestinal stromal tumors(68.0%,P<0.001).Tumor recurrence occurred in one LWR patient(4.0%,P=0.600).En bloc and macroscopic resection rates were 100%(P=1.000),but microscopic resection rates differed(P=0.021).Significant minor complications occurred in 5 patients(10.0%),all grade IIIa.Tumor location(cardia/fundus,P=0.006)and prolonged procedure time(P<0.001)were significantly associated with complications.CONCLUSION ESD,STER,and LWR are effective for SMTs at the EGJ and cardia,with minor complications associated with tumor location and procedure time,and comparable recurrence rates.
基金Supported by the Engineering Training Funds in Shenzhen,No.SYLY201718,No.SYJY201714,and No.SYLY201801Technical Research and Development Project of Shenzhen,No.JCYC20170307100911479,No.JCYJ20190807145617113,No.JCYJ20210324113802006.
文摘BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs.AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection(ESMR-L)following unroofing technique for small esophageal SEL-MPs.METHODS From January 2021 to September 2023,17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People’s Hospital.Details of clinicopathological characteristics and clinical outcomes were collected and analyzed.RESULTS The mean age of the patients was 50.12±12.65 years.The mean size of the tumors was 7.47±2.83 mm and all cases achieved en bloc resection successfully.The average operation time was 12.2 minutes without any complications.Histopathology identified 2 Lesions(11.8%)as gastrointestinal stromal tumors at very low risk,12 Lesions(70.6%)as leiomyoma and 3 Lesions(17.6%)as smooth muscle proliferation.No recurrence was found during the mean follow-up duration of 14.18±9.62 months.CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm,but it cannot ensure en bloc resection and may require further treatment.
文摘AIM:To explore endoscopic therapy methods for gastric stromal tumors originating from the muscularis propria.METHODS:For 69 cases diagnosed as gastric stromal tumors originating from the muscularis propria,three types of endoscopic therapy were selected,based on the size of the tumor.These methods included endoscopic ligation and resection(ELR),endoscopic submucosal excavation(ESE) and endoscopic full-thickness resection(EFR).The wound surface and the perforation of the gastric wall were closed with metal clips.Immunohistostaining for CD34,CD117,Dog-1,S-100 and smooth muscle actin(SMA) was performed on the resected tumors.RESULTS:A total of 38 cases in which the tumor size was less than 1.2 cm were treated with ELR;three cases were complicated by perforation,and the perforations were closed with metal clips.Additionally,18 cases in which the tumor size was more than 1.5 cm were treated with ESE,and no perforation occurred.Finally,13 cases in which the tumor size was more than 2.0 cm were treated with EFR;all of the cases were complicated by artificial perforation,and all of the perforations were closed with metal clips.All of the 69 cases recovered with medical treatment,and none required surgical operation.Immunohistostaining demonstrated that among all of the 69 gastric stromal tumors diagnosed by gastroscopy,12 cases were gastric leiomyomas(SMA-positive),and the other 57 cases were gastric stromal tumors.CONCLUSION:Gastric stromal tumors originating from the muscularis propria can be treated successfully with endoscopic techniques,which could replace certain surgical operations and should be considered for further application.
基金Supported by Natural Science Foundation of Shandong Province,No.ZR2013HM004
文摘AIM: To evaluate the efficacy, safety and feasibility of endoscopic full-thickness resection (EFR) for the treatment of gastric submucosal tumors (SMTs) arising from the muscularis propria.
文摘AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria(SMTMPs).METHODS By reviewing the computerized medical records over a period of 14 years(2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound(EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in 2016.RESULTS A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors(GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until 2016.CONCLUSION Most 1-3 cm gastric SMTMPs(71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size(> 14.0 mm) and irregular border.
基金Supported by Faculty of Medicine,Ramathibodi Hospital,Mahidol University,Thailand
文摘Visceral myopathy is one of the causes of chronic intestinal pseudo-obstruction. Most cases pathologically reveal degenerative changes of myocytes or muscularis propia atrophy and fibrosis. Abnormal layering of muscularis propria is extremely rare. We report a case of a 9-mo-old Thai male baby who presented with chronic intestinal pseudo-obstruction. Histologic findings showed abnormal layering of small intestinal muscularis propria with an additional oblique layer and aberrant muscularization in serosa. The patient also had a short small bowel without malrotation, brachydactyly,and absence of the 2nd to 4th middle phalanges of both hands. The patient was treated with cisapride and combined parenteral and enteral nutritional support.He had gradual clinical improvement and gained body weight. Subsequently, the parenteral nutrition was discontinued. The previously reported cases are reviewed and discussed.
基金Supported by Science and Technology Commission of Shanghai Municipality,China,No.19411951505.
文摘BACKGROUND Endoscopic resection approaches,including endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER)and endoscopic fullthickness resection(EFTR),have been widely used for the treatment of submucosal tumors(SMTs)located in the upper gastrointestinal tract.However,compared to SMTs located in the esophagus or stomach,endoscopic resection of SMTs from the esophagogastric junction(EGJ)is much more difficult because of the sharp angle and narrow lumen of the EGJ.SMTs originating from the muscularis propria(MP)in the EGJ,especially those that grow extraluminally and adhere closely to the serosa,make endoscopic resection even more difficult.AIM To investigate the predictors of difficult endoscopic resection for SMTs from the MP layer at the EGJ.METHODS A total of 90 patients with SMTs from the MP layer at the EGJ were included in the present study.The difficulty of endoscopic resection was defined as a long procedure time,failure of en bloc resection and intraoperative bleeding.Clinicopathological,endoscopic and follow-up data were collected and analyzed.Statistical analysis of independent risks for piecemeal resection,long operative time,and intraoperative bleeding were assessed using univariate and multivariate analyses.RESULTS According to the location and growth pattern of the tumor,44 patients underwent STER,14 patients underwent EFTR,and the remaining 32 patients received a standard ESD procedure.The tumor size was 20.0 mm(range 5.0–100.0 mm).Fourty-seven out of 90 lesions(52.2%)were regularly shaped.The overall en bloc resection rate was 84.4%.The operation time was 43 min(range 16–126 min).The intraoperative bleeding rate was 18.9%.There were no adverse events that required therapeutic intervention during or after the procedures.The surgical approach had no significant correlation with en bloc resection,long operative time or intraoperative bleeding.Large tumor size(≥30 mm)and irregular tumor shape were independent predictors for piecemeal resection(OR:7.346,P=0.032 and OR:18.004,P=0.029,respectively),long operative time(≥60 min)(OR:47.330,P=0.000 and OR:6.863,P=0.034,respectively)and intraoperative bleeding(OR:20.631,P=0.002 and OR:19.020,P=0.021,respectively).CONCLUSION Endoscopic resection is an effective treatment for SMTs in the MP layer at the EGJ.Tumors with large size and irregular shape were independent predictors for difficult endoscopic resection.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 81470909）.
文摘Background： Gastric stromal tumors arising from the muscularis propria are located in deeper layers. Endoscopic resection may be contraindicated due to the possibility of perforation. These tumors are therefore usually removed by surgical or laparoscopic procedures. This study evaluated the curative effects, safety and feasibility of endoscopic full-thickness resection （EFR） of gastric stromal tumors originating from the muscularis propria. Methods： This study enrolled 92 patients with gastric stromal tumors 〉2.5 cm originating from the muscularis propria. Fifty patients underwent EFR, and 42 underwent laparoscopic intragastric surgery. Operation time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared in these two groups. Results： EFR resulted in complete resection of all 50 gastric stromal tumors, with a mean procedure time of 85± 20 min, a mean hospitalization time of 7.0± 1.5 days and no complications. Laparoscopic intragastric surgery also resulted in a 100% complete resection rate, with a mean operation time of 88 ± 12 min and a mean hospitalization period of 7.5 ± 1.6 days. The two groups did not differ significantly in operation time, complete resection rates, hospital stay or incidence of complications （P 〉 0.05）. No patient in either group experienced tumor recurrence. Conclusions： EFR technique is effective and safe for the resection of gastric stromal tumors arising from the muscularis propria.
文摘Background Gastric stromal tumors are the most common type of tumor originating from mesenchymal tissue. The traditional method for the treatment of gastric stromal tumor is surgical operation or therapeutic laparoscopy. More recently, endoscopic micro-traumatic surgery has become possible for gastric stromal tumors, with any perforation caused by endoscopic therapy mended endoscopically. We assessed the effectiveness of endoscopic full-thickness resection （EFR） in the treatment of gastric stromal tumors arising from the muscularis propria. Methods Of the 42 gastric stromal tumors, each 〉2.0 cm in diameter, arising from the muscularis propria, 22 were removed by EFR and 20 by laparoscopic surgery. Tumor expression of CD34, CDl17, Dog-l, S-100, and smooth muscle actin （SMA） was assessed immunohistochemically. Operating time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared between the two groups. Continuous data were compared by using independent samples t-tests and categorical data by using Xz tests. Results Comparisons of the 22 gastric stromal tumors treated with EFR and the 20 treated with laparoscopic surgery showed similar operation times （60-155 minutes （mean, （90±17） minutes） vs. 50-210 minutes （mean, （95±21） minutes）, P 〉0.05）, complete resection rates （100% vs. 95%, P 〉0.05）, and length of hospital stay （4-10 days （mean, （6.0±1.8） days） vs. 4-12 days （mean, （7.3±1.7） days）, P 〉0.05）. None of the patients treated with EFR experienced complications, whereas one patient treated with laparoscopy required a conversion to laparotomy and one experienced postoperative gastroparesis. No recurrences were observed in either group. stromal tumors diagnosed by gastroscopy and endoscopic remaining 36 were stromal tumors. mmunohistochemical staining showed that of the 42 gastric ultrasound, six were leiomyomas （SMA-positive） and the Conclusions Gastric stromal tumors arising from the muscularis propria can be completely removed by EFR. EFR may replace surcjical or laparoscopic procedures for the removal of gastric stromal tumors.
文摘INTRODUCTION Gastric stromal tumor （GST） is a set of gastrointestinal mesenchymal tumors those originate from interstitial cells of Cajal. Its early diagnosis and treatment are critical to prognosis. The occurrence of GST remains obscure; this study used Affymetrix expression spectrum chip to detect the gene expression spectrum of GST and explore new molecular target that is used in the treatment and prognosis of GST.
文摘For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.
基金Supported by Natural Science Foundation of Shandong Province,No.ZR2013HM004
文摘AIM: To assess the effectiveness of endoscopic full-thickness resection (EFR) and laparoscopic surgery in the treatment of gastric stromal tumors arising from the muscularis propria.
