ENDOSCOPIC FULL-THICKNESS RESECTION FOR GASTRIC SUBMUCOSAL TUMOR (WITH VIDEOS)

Abstract

Endoscopic full-thickness resection (EFTR) of the stomach has been performed as a minimally invasive treatment for gastric submucosal tumors (SMTs), including gastrointestinal stromal tumors. SMTs with an intraluminal growth type, ＜3cm in diameter, and no ulceration are good candidates for EFTR. Among them, SMTs located in the lesser curvature are the best indication for EFTR because the mesogastrium attaches widely to the gastric serosa in such a location. The mesogastrium works as a barrier to gas flowing out of the stomach after active perforation during EFTR. The mesogastrium can help stop or, at least minimize, the escape of gas from the stomach into the peritoneal cavity; therefore, it is possible to continue endoscopic procedures under a good visual field. “Traction” is known to be one of the key steps in EFTR. Traction methods widely used in standard ESD may be insufficient due to the weight of the tumor. Devices for strong and effective traction used by the authorsʼ for EFTR are presented in this article. Additionally, perioperative management, actual procedures, and some trouble-shooting tips for EFTR are discussed.