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Hybrid push-pull endoscopic and laparoscopic full thickness resection for the minimally invasive management of gastrointestinal stromal tumors: a pilot clinical study.

Willingham FF, Reynolds P, Lewis M, Ross A, Maithel SK, Rocha FG - Gastroenterol Res Pract (2015)

Bottom Line: Methods.Conclusion.Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection.

View Article: PubMed Central - PubMed

Affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.

ABSTRACT
Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors. Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management. Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens. Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.

No MeSH data available.


Related in: MedlinePlus

Image from a computed tomography scan demonstrating an endophytic tumor arising in a challenging location in the gastric antrum.
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Related In: Results  -  Collection


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fig2: Image from a computed tomography scan demonstrating an endophytic tumor arising in a challenging location in the gastric antrum.

Mentions: The second patient presented with dysphagia and underwent a computed tomography (CT) scan (Figure 2) and subsequent EGD which demonstrated an endophytic 4 cm submucosal mass in the antrum of the stomach. Superficial biopsies were nondiagnostic. An EUS was performed. The case was reviewed and the patient was brought for a hybrid push-pull resection. Due to the highly endophytic nature of the mass, it was resected endoscopically in two sections. The latter resection required a full thickness excision resulting in a gastrotomy. This was closed laparoscopically with a stapler. Pathologic examination of the specimen demonstrated a tumor approximately 4.2 cm in length with a mitotic rate of 1 mitosis/50 hpf and final negative margins.


Hybrid push-pull endoscopic and laparoscopic full thickness resection for the minimally invasive management of gastrointestinal stromal tumors: a pilot clinical study.

Willingham FF, Reynolds P, Lewis M, Ross A, Maithel SK, Rocha FG - Gastroenterol Res Pract (2015)

Image from a computed tomography scan demonstrating an endophytic tumor arising in a challenging location in the gastric antrum.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4402559&req=5

fig2: Image from a computed tomography scan demonstrating an endophytic tumor arising in a challenging location in the gastric antrum.
Mentions: The second patient presented with dysphagia and underwent a computed tomography (CT) scan (Figure 2) and subsequent EGD which demonstrated an endophytic 4 cm submucosal mass in the antrum of the stomach. Superficial biopsies were nondiagnostic. An EUS was performed. The case was reviewed and the patient was brought for a hybrid push-pull resection. Due to the highly endophytic nature of the mass, it was resected endoscopically in two sections. The latter resection required a full thickness excision resulting in a gastrotomy. This was closed laparoscopically with a stapler. Pathologic examination of the specimen demonstrated a tumor approximately 4.2 cm in length with a mitotic rate of 1 mitosis/50 hpf and final negative margins.

Bottom Line: Methods.Conclusion.Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection.

View Article: PubMed Central - PubMed

Affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.

ABSTRACT
Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors. Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management. Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens. Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.

No MeSH data available.


Related in: MedlinePlus