ABSTRACT
OBJECTIVE: To explore the efficacy and safety of endoscopic submucosal enucleation (ESE) for gastric submucosal tumors (SMTs) originated from muscularis propria. METHODS: A total of 116 patients with gastric SMT originated from muscularis propria underwent ESE in Department of Gastroenterology of the Taizhou Hospital between July 2006 and March 2011. The occurrence of intra-operative and post-operative complications and corresponding treatment were recorded. After the treatment of ESE, the patients were followed up endoscopically. RESULTS: The success rate of operation was 96.6%. The mean time of the procedure was (51.9±16.3) min. Complications included intra-operative bleeding (n=9, 7.8%), perforation (n=20, 17.2%), and post-operative bleeding (n=3, 2.6%). Among them, 5 cases (4.3%) required surgical intervention. None of patient had other complications such as peritoneal abscess or peritonitis. The mean hospitalization time after ESE was 6.1 days. The median follow-up period was 12 months (range, 3-48 months) and there was no residual tumor or recurrence. CONCLUSION: ESE is a safe and feasible treatment for patients with gastric SMT originated from muscularis propria.
Subject(s)
Gastrectomy/methods , Gastroscopy/methods , Stomach Neoplasms/surgery , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: Gastric gastrointestinal stromal tumors (gastric GISTs) are the most common gastric submucosal tumors with potential for malignant transformation. Our aim was to assess the efficacy and safety of ESE for gastric GISTs. METHODOLOGY: Small gastric GISTs were dealt with ESE between May 2007 and October 2010. RESULTS: A total of 69 patients (42 men, 27 women; mean age 47.28±10.10 years) were treated. The mean diameter of the specimens was 1.87±0.57cm (range 0.7-3.0cm). The rates of intra-operative bleeding, delayed bleeding, perforation and surgery related complications were 7.25% (5/69), 1.45% (1/69), 33.33% (23/69) and 5.80% (4/69), respectively. The rate of perforation was 43.2% (19/44) at the fundus of the stomach and 16% (4/25) at the body (p=0.02). The mean time of the procedure was 41.07±10.79 minutes. Nineteen patients with perforation were treated by titanium clips and the rest by laparoscopy. Immunohistochemistry revealed that the positive rates of CD117 and CD34 were 88.41% and 68.12%, respectively. The gastric GISTs were all at low risk. At a mean follow-up period of 17.97±10.75 months (range 1 to 40 months) all of the patients were disease free. CONCLUSIONS: ESE with a cross-shaped incision is possibly a very good choice for small gastric GISTs.
Subject(s)
Endoscopy, Gastrointestinal/methods , Gastric Mucosa/surgery , Gastrointestinal Stromal Tumors/surgery , Stomach Neoplasms/surgery , Adult , Aged , Antigens, CD34/analysis , Biomarkers, Tumor/analysis , Biopsy , Blood Loss, Surgical , Endoscopy, Gastrointestinal/adverse effects , Endosonography , Female , Gastric Mucosa/chemistry , Gastric Mucosa/pathology , Gastrointestinal Stromal Tumors/chemistry , Gastrointestinal Stromal Tumors/pathology , Humans , Immunohistochemistry , Male , Middle Aged , Mitosis , Postoperative Complications/etiology , Postoperative Complications/surgery , Proto-Oncogene Proteins c-kit/analysis , Reoperation , Stomach Neoplasms/chemistry , Stomach Neoplasms/pathology , Time Factors , Treatment Outcome , Tumor Burden , Young AdultABSTRACT
BACKGROUND/AIMS: Capsule endoscopy (CE) reaches the cecum in about 80% of cases. Decreasing the gastric transit time (GTT) may increase the complete examination rate (CER). METHODOLOGY: Patients (n=177) were prospectively randomized into 2 groups: the control group (n=88) and the intramuscular injection with metoclopramide (IIM) group (n=89). The OMOM CE system, which has the function of real-time monitoring, was used. The patients were injected with metoclopramide 15 minutes before swallowing the CE in the IIM group. The CE would be sent into the duodenum by gastroscopy if the GTT reached 120 minutes in the two groups. RESULTS: No significant difference was noted between the two groups. Of the 169 cases without gastroscopic help, the mean GTT was shorter in the IIM group (n=87) than the control group (n=82) (p=0.002). But the CER was similar. Of 135 cases without gastroscopic help but reached the cecum, the mean GTT was shorter in the IIM group (n=71) than the control group (n=64) (p=0.015). But the mean small bowel transit time (SBTT) was similar. CONCLUSIONS: Intramuscular injection of metoclopramide decreases the gastric transit time, but it does not change the SBTT or CER of capsule endoscopy in our study.