title: Factors associated with endoscopic full-thickness resection of gastric submucosal tumors.
abstract: OBJECTIVE
  To identify factors that impact the procedure and treatment outcomes for endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs).
  
  
  METHODS
  Medical records were collected for all patients with gastric SMTs who underwent EFTR procedures in Shengjing Hospital between June 2012 and April 2014. The data from each patient were reviewed, including gender, age, maximum tumor size on endoscopic ultrasound (EUS), tumor location in stomach, length of EFTR procedure, pneumoperitoneum during EFTR, cost to close defects, length of hospital stay after the procedure, and procedure-related complications.
  
  
  RESULTS
  Endoscopic full-thickness resection of gastric SMTs was successfully performed in all 41 patients. Maximum size on EUS [parameter estimate (PE) = 4.443, 95% confidence interval (CI) 2.191-6.695; p = 0.000] and tumor location in the greater curvature (PE = 44.441, 95% CI 5.539-83.343; p = 0.026) were significantly associated with the length of the procedure. A pneumoperitoneum was more likely to occur during EFTR in tumors with a larger EUS size [odds ratio (OR) = 1.415, 95% CI 1.034-1.936; p = 0.03], and less likely to occur during EFTR for tumors located in the posterior wall (OR = 0.003, 95% CI 0-0.351; p = 0.017). The use of the over-the-scope clip (OTSC) system was significantly associated with shorter hospital stays (PE = -1.006, 95% CI -1.998 to -0.014; p = 0.047) and a higher cost of closing defects (PE = 854.742, 95% CI 358.377-1351.107; p = 0.001).
  
  
  CONCLUSIONS
  Endoscopic full-thickness resection is an effective and safe method for removing gastric SMTs. Tumor size on EUS and location of the tumor were associated with the duration of EFTR and the occurrence of a pneumoperitoneum during the procedure. The use of an OTSC system was significantly associated with shorter hospital stays and a higher cost of closing defects.
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China. dr_yangfei@sina.com.
authors.forename: Fei
authors.initials: F
authors.lastname: Yang
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Wang
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China. dr_sunsiyu@163.com.
authors.forename: Siyu
authors.initials: S
authors.lastname: Sun
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Ge
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Wang
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Jintao
authors.initials: J
authors.lastname: Guo
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Liu
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Linlin
authors.initials: L
authors.lastname: Feng
authors.affiliation: Endoscopic Center, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
authors.forename: Wenzhuang
authors.initials: W
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011027:Pneumoperitoneum / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic full-thickness resection; Gastric submucosal tumor; Risk factors