Endoscopic full-thickness resection for gastric submucosal tumors: Japanese multicenter prospective study

Satoki Shichijo; Noriya Uedo; Atsushi Sawada; Kingo Hirasawa; Hirohisa Takeuchi; Nobutsugu Abe; Masaki Miyaoka; Kenshi Yao; Akira Dobashi; Kazuki Sumiyama; Tsukasa Ishida; Yoshinori Morita; Hiroyuki Ono

doi:10.1111/den.14717

Endoscopic full-thickness resection for gastric submucosal tumors: Japanese multicenter prospective study

Dig Endosc. 2023 Nov 1. doi: 10.1111/den.14717. Online ahead of print.

Authors

Affiliations

¹ Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
² Endoscopy Division, Yokohama City University Medical Center, Kanagawa, Japan.
³ Department of Gastroenterological and General Surgery, Kyorin University School of Medicine, Tokyo, Japan.
⁴ Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
⁵ Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
⁶ Department of Gastroenterology, Akashi Medical Center, Hyogo, Japan.
⁷ Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan.
⁸ Endoscopy Division, Shizuoka Cancer Center, Shizuoka, Japan.

PMID: 37914400
DOI: 10.1111/den.14717

Abstract

Objectives: Early gastric cancer endoscopic resection (ER) is prominent in Japan. However, evidence regarding ER of gastric submucosal tumors (SMT) is limited. This prospective multicenter phase II study investigated the efficacy and safety of endoscopic full-thickness resection (EFTR) for gastric SMT.

Methods: Endoscopic full-thickness resection indication for gastric SMT was 11-30 mm, histologically proven or clinically suspicious (irregular margin, increasing size, or internal heterogeneity) gastrointestinal stromal tumors (GIST), with no ulceration and intraluminal growth type. The primary end-point was the complete ER (ER0) rate, with a sample size of 42.

Results: We enrolled 46 patients with 46 lesions between September 2020 and May 2023 at seven Japanese institutions. The mean ± SD (range) endoscopic tumor size was 18.8 ± 4.5 (11-28) mm. The tumor resection and defect closure times were 54 ± 26 (22-125) min and 33 ± 28 (12-186) min, respectively. A 100% ER0 was achieved in all 46 patients. The EFTR procedure was accomplished in all patients without surgical intervention. One patient had delayed perforation and was managed endoscopically. GIST accounted for 76% (n = 35) of the cases. R0, R1, and RX rates were 33 (77%), 3 (6.5%), and 7 (15%), respectively.

Conclusion: Endoscopic full-thickness resection for gastric SMT of 11-30 mm is efficacious. It warrants further validation in a large-scale cohort study to determine the long-term outcome of this treatment for patients with gastric GIST.

Keywords: endoscopy; full-thickness resection; gastrointestinal stromal tumor; phase II study; submucosal tumor.