title: Endoscopic full-thickness resection for gastric submucosal tumors arising from the muscularis propria layer.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A total of 35 gastric SMTs arising from the muscularis propria layer were resected by EFR between January 2010 and September 2013. EFR consists of five major steps: injecting normal saline into the submucosa; pre-cutting the mucosal and submucosal layers around the lesion; making a circumferential incision as deep as the muscularis propria around the lesion using endoscopic submucosal dissection and an incision into the serosal layer around the lesion with a Hook knife; a full-thickness resection of the tumor, including the serosal layer with a Hook or IT knife; and closing the gastric wall with metallic clips.
  
  
  RESULTS
  Of the 35 gastric SMTs, 14 were located at the fundus, and 21 at the corpus. EFR removed all of the SMTs successfully, and the complete resection rate was 100%. The mean operation time was 90 min (60-155 min), the mean hospitalization time was 6.0 d (4-10 d), and the mean tumor size was 2.8 cm (2.0-4.5 cm). Pathological examination confirmed the presence of gastric stromal tumors in 25 patients, leiomyomas in 7 and gastric autonomous nerve tumors in 2. No gastric bleeding, peritonitis or abdominal abscess occurred after EFR. Postoperative contrast roentgenography on the third day detected no contrast extravasation into the abdominal cavity. The mean follow-up period was 6 mo, with no lesion residue or recurrence noted.
  
  
  CONCLUSIONS
  EFR is efficacious, safe and minimally invasive for patients with gastric SMTs arising from the muscularis propria layer. This technique is able to resect deep gastric lesions while providing precise pathological information about the lesion. With the development of EFR, the indications of endoscopic resection might be extended.
authors.affiliation: Liu-Ye Huang, Jun Cui, Shu-Juan Lin, Bo Zhang, Cheng-Rong Wu, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China.
authors.forename: Liu-Ye
authors.initials: LY
authors.lastname: Huang
authors.affiliation: Liu-Ye Huang, Jun Cui, Shu-Juan Lin, Bo Zhang, Cheng-Rong Wu, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Cui
authors.affiliation: Liu-Ye Huang, Jun Cui, Shu-Juan Lin, Bo Zhang, Cheng-Rong Wu, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China.
authors.forename: Shu-Juan
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Liu-Ye Huang, Jun Cui, Shu-Juan Lin, Bo Zhang, Cheng-Rong Wu, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Liu-Ye Huang, Jun Cui, Shu-Juan Lin, Bo Zhang, Cheng-Rong Wu, Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China.
authors.forename: Cheng-Rong
authors.initials: CR
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011027:Pneumoperitoneum / Q000209:etiology / Q000628:therapy; D011677:Punctures; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endoscopic full-thickness resection; Excision; Muscularis propria layer; Stomach; Submucosal tumor