title: Cap-aspiration lumpectomy for small submucosal tumors originating from the muscularis propria of the gastric fundus: a preliminary study (with videos).
abstract: OBJECTIVE
  Small fundal submucosal tumors (SMTs) originated from the muscularis propria pose great difficulties to conventional therapies. We aimed to evaluate the feasibility and safety of endoscopic cap-aspiration lumpectomy (CASL) as a new and simple full-thickness resection for the treatment of small fundal SMTs.
  
  
  METHODS
  From July 2013 to February 2014, patients with small fundal SMTs of ≤10 mm in diameter that were originated from muscularis propria were included in the study. CASL was performed by suctioning SMTs into a transparent cap, ligating with a metal snare and resecting the tumors. The wall deficit was closed by using endoclips.
  
  
  RESULTS
  Altogether 28 patients were included in the study. CASL achieved an en bloc resection rate of 100%, with a mean total procedure time of 23.9 min. Active perforation was found in 20 (71.4%) patients, and endoclips closed the wall defect in all 20 cases. One patient developed pneumoperitoneum and self-limited peritonitis was found in two patients, all of whom were managed successfully. Pathological examination showed that 71.4% (20/28) of the tumors were gastrointestinal stromal tumors. No tumor recurrence was observed during the follow-up.
  
  
  CONCLUSIONS
  CASL may be a feasible and safe full-thickness resection modality for the treatment of small fundal SMTs arising from the muscularis propria. Further randomized studies are needed to confirm the results.
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Wei Guang
authors.initials: WG
authors.lastname: Qiao
authors.affiliation: Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China.
authors.forename: Yu Tang
authors.initials: YT
authors.lastname: Ren
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Wei
authors.initials: W
authors.lastname: Gong
authors.affiliation: Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Si De
authors.initials: SD
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhou
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Tong Yin
authors.initials: TY
authors.lastname: Xing
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Yang
authors.initials: Y
authors.lastname: Bai
authors.affiliation: Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province.
authors.forename: Fa Chao
authors.initials: FC
authors.lastname: Zhi
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D005748:Gastric Fundus; D005753:Gastric Mucosa; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013396:Suction / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: cap-aspiration lumpectomy; gastric fundus; muscularis propria; submucosal tumor