title: Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria.
abstract: BACKGROUND
  This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria.
  
  
  METHODS
  Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips.
  
  
  RESULTS
  EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60-145) min. The mean resected lesion size was 2.8 (range, 1.2-4.5) cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8 months; range, 6-24 months).
  
  
  CONCLUSIONS
  EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, People's Republic of China.
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.forename: Xin-Yu
authors.initials: XY
authors.lastname: Qin
authors.forename: Ming-Yan
authors.initials: MY
authors.lastname: Cai
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Wen-Zheng
authors.initials: WZ
authors.lastname: Qin
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Hu
authors.forename: Jing-Zheng
authors.initials: JZ
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D005918:Glomus Tumor / Q000473:pathology / Q000601:surgery; D006801:Humans; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology*; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome