Application of NOTES combined with ESD for the treatment of an exogenous gastric stromal tumor: A case report and review of the literature

Liu,Xiao-Bo; Gao,Zi-Ye; Pandey,Sandeep; Shan,Bao-Zhen; Liu,Ping; Sun,Chuan-Tao; Li,Sheng-Bao; Jin,Shu

doi:10.3892/wasj.2020.78

Application of NOTES combined with ESD for the treatment of an exogenous gastric stromal tumor: A case report and review of the literature

Authors:
- Xiao-Bo Liu
- Zi-Ye Gao
- Sandeep Pandey
- Bao-Zhen Shan
- Ping Liu
- Chuan-Tao Sun
- Sheng-Bao Li
- Shu Jin
View Affiliations

Affiliations: Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China, Department of Oncology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China, Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
Published online on: December 8, 2020 https://doi.org/10.3892/wasj.2020.78
Article Number: 7
Copyright: © Liu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to investigate the safety and feasibility of natural orifice transluminal endoscopic surgery (NOTES) combined with endoscopic mucosal dissection (ESD) as a treatment for the exogenous growth of gastric stromal tumors of the serosal layer. The clinical data of one patient presenting with the growth of an exogenous gastric stromal tumor of the serosal layer admitted to the Department of Gastroenterology, Taihe Hospital, were reviewed. The patient's condition was evaluated pre‑operatively, and NOTES combined with ESD were performed under general anesthesia. PubMed, EMbase, Wanfang data, the China National Knowledge Infrastructure and other databases, combined with the published literature were also searched to evaluate the safety and feasibility of this type of treatment for gastrointestinal stromal tumors (GISTs). In the present study, the duration of the surgery was 110 min, intraoperative blood loss was approximately 5 ml, and the lesion was completely stripped. After 5 days, the patient resumed a normal diet. After 45 days, the wound healing of the gastroscope was complete. An abdominal CT scan revealed that the tumor had been completely removed. In general, the endoscopic treatment of GISTs has a number of advantages; however, large lesions limit its application. Laparoscopic and endoscopic techniques have expanded the indications for GIST surgery to reduce contamination and tumor dissemination risks. NOTES technology is a novel direction for the treatment of GISTs, and its combination combined with ESD is safe and feasible. On the whole, as demonstrated herein, NOTES combination with ESD is safe and feasible for the treatment of GISTs originating from the gastric serosa or extraluminal growth type, particularly when the lesion is <3.5 cm in diameter. This method may thus be worthy of clinical promotion.

View Figures

View References

1	Menge F, Jakob J, Kasper B, Smakic A, Gaiser T and Hohenberger P: Clinical presentation of gastrointestinal stromal tumors. Visc Med. 34:335–340. 2018.PubMed/NCBI View Article : Google Scholar
2	Chun SY, Kim KO, Park DS, Lee IJ, Park JW, Moon SH, Baek IH, Kim JH, Park CK and Kwon MJ: Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: A preliminary analysis of appropriate indications. Surg Endosc. 27:3271–3279. 2013.PubMed/NCBI View Article : Google Scholar
3	Koo DH, Ryu MH, Kim KM, Yang HK, Sawaki A, Hirota S, Zheng J, Zhang B, Tzen CY, Yeh CN, et al: Asian consensus guidelines for the diagnosis and management of gastrointestinal stromal tumor. Cancer Res Treat. 48:1155–1166. 2016.PubMed/NCBI View Article : Google Scholar
4	Xu C, Chen T, Hu Y, Balde AI, Liu H, Yu J, Zhen L and Li G: Retrospective study of laparoscopic versus open gastric resection for gastric gastrointestinal stromal tumors based on the propensity score matching method. Surg Endosc. 31:374–381. 2017.PubMed/NCBI View Article : Google Scholar
5	Zhang Y, Ye LP and Mao XL: Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer. World J Gastroenterol. 21:9503–9511. 2015.PubMed/NCBI View Article : Google Scholar
6	Wang W, Shi X, Jin Z, et al: Key issues about the endoscopic treatment for upper gastrointestinal submucosal tumors. Chin J Dig Endosc. 34:764–768. 2017.DOI: 10.3760/cma.j.issn.1007-5232.2017.11.002.
7	Bernhardt J, Sasse S, Ludwig K and Meier PN: Update in Natural Orifice Translumenal Endoscopic Surgery (NOTES). Curr Opin Gastroenterol. 33:346–351. 2017.PubMed/NCBI View Article : Google Scholar
8	Shiroshita H, Etoh T, Yasuda K, Inomata M and Kitano S: Natural orifice translumenal endoscopic surgery. Nihon Geka Gakkai Zasshi. 117:376–380. 2016.PubMed/NCBI(In Japanese).
9	Zhou PH, Cai MY and Yao LQ: Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumor (Version 2018). Zhonghua Wei Chang Wai Ke Za Zhi. 21:841–852. 2018.PubMed/NCBI(In Chinese).
10	Cai JQ, Chen K, Mou YP, Pan Y, Xu XW, Zhou YC and Huang CJ: Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: A single-center 8-year retrospective cohort study of 156 patients with long-term follow-up. BMC Surg. 15(58)2015.PubMed/NCBI View Article : Google Scholar
11	Matsuda T, Nunobe S, Kosuga T, Kawahira H, Inaki N, Kitashiro S, Abe N, Miyashiro I, Nagao S, Nishizaki M, et al: Society for the Study of Laparoscopy and Endoscopy Cooperative Surgery. Laparoscopic and luminal endoscopic cooperative surgery can be a standard treatment for submucosal tumors of the stomach: A retrospective multicenter study. Endoscopy. 49:476–483. 2017.PubMed/NCBI View Article : Google Scholar
12	Nunobe S, Hiki N, Gotoda T, Murao T, Haruma K, Matsumoto H, Hirai T, Tanimura S, Sano T and Yamaguchi T: Successful application of laparoscopic and endoscopic cooperative surgery (LECS) for a lateral-spreading mucosal gastric cancer. Gastric Cancer. 15:338–342. 2012.PubMed/NCBI View Article : Google Scholar
13	Ye X, Yu J, Kang W, Ma Z and Xue Z: Short- and long-term outcomes of endoscope-assisted laparoscopic wedge resection for gastric submucosal tumors adjacent to esophagogastric junction. J Gastrointest Surg. 22:402–413. 2018.PubMed/NCBI View Article : Google Scholar
14	Mahawongkajit P and Chanswangphuvana P: Laparoscopy-assisted endoscopic full-thickness resection of upper gastrointestinal subepithelial tumors: A single-center early experience. Mol Clin Oncol. 12:461–467. 2020.PubMed/NCBI View Article : Google Scholar
15	Hajer J, Havlůj L, Whitley A and Gürlich R: Non-exposure endoscopic-laparoscopic cooperative surgery for stomach tumors: First experience from the Czech republic. Clin Endosc. 51:167–173. 2018.PubMed/NCBI View Article : Google Scholar
16	Kikuchi S, Nishizaki M, Kuroda S, Tanabe S, Noma K, Kagawa S, Shirakawa Y, Kato H, Okada H and Fujiwara T: Nonexposure laparoscopic and endoscopic cooperative surgery (closed laparoscopic and endoscopic cooperative surgery) for gastric submucosal tumor. Gastric Cancer. 20:553–557. 2017.PubMed/NCBI View Article : Google Scholar
17	Okumura S, Kanaya S, Hosogi H, Ito T, Miura S, Okada T, Shimoike N, Akagawa S, Kawada H and Arimoto A: Our experience with laparoscopic partial gastrectomy by the ‘lift-and-cut method’ for gastric gastrointestinal stromal tumor with maximal preservation of the remnant stomach. Surg Endosc. 31:3398–3404. 2017.PubMed/NCBI View Article : Google Scholar
18	Dong HY, Wang YL, Jia XY, Li J, Li GD and Li YQ: Modified laparoscopic intragastric surgery and endoscopic full-thickness resection for gastric stromal tumor originating from the muscularis propria. Surg Endosc. 28:1447–1453. 2014.PubMed/NCBI View Article : Google Scholar
19	Moriyama H, Ishikawa N, Kawaguchi M, Hirose K and Watanabe G: Robot-assisted laparoscopic resection for gastric gastrointestinal stromal tumor. Surg Laparosc Endosc Percutan Tech. 22:e155–e156. 2012.PubMed/NCBI View Article : Google Scholar
20	Lee SH, Kim SJ, Lee TH, Chung IK, Park SH, Kim EO, Lee HJ and Cho HD: Human applications of submucosal endoscopy under conscious sedation for pure natural orifice transluminal endoscopic surgery. Surg Endosc. 27:3016–3020. 2013.PubMed/NCBI View Article : Google Scholar
21	Mori H, Kobara H, Kobayashi M, Muramatsu A, Nomura T, Hagiike M, Izuishi K, Suzuki Y and Masaki T: Establishment of pure NOTES procedure using a conventional flexible endoscope: Review of six cases of gastric gastrointestinal stromal tumors. Endoscopy. 43:631–634. 2011.PubMed/NCBI View Article : Google Scholar
22	Nakajima K, Nishida T, Takahashi T, Souma Y, Hara J, Yamada T, Yoshio T, Tsutsui T, Yokoi T, Mori M, et al: Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: Early experience in humans. Surg Endosc. 23:2650–2655. 2009.PubMed/NCBI View Article : Google Scholar
23	Zhou P, Zhong Y and Li Q: Chinese consensus on endoscopic diagnosis and management of gastrointestinal submucosal tumor (version 2018). Zhonghua Wei Chang Wai Ke Za Zhi. 21:841–852. 2018.PubMed/NCBI(In Chinese).
24	Ponsaing LG and Hansen MB: Therapeutic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol. 13:3316–3322. 2007.PubMed/NCBI View Article : Google Scholar
25	Jumniensuk C and Charoenpitakchai M: Gastrointestinal stromal tumor: Clinicopathological characteristics and pathologic prognostic analysis. World J Surg Oncol. 16(231)2018.PubMed/NCBI View Article : Google Scholar
26	Kim HH: Endoscopic treatment for gastrointestinal stromal tumor: Advantages and hurdles. World J Gastrointest Endosc. 7:192–205. 2015.PubMed/NCBI View Article : Google Scholar
27	Liu J, Huang C, Peng C, Xu F, Li Y, Yutaka Y, Xiong B and Yang X: Stromal fibroblast activation protein alpha promotes gastric cancer progression via epithelial-mesenchymal transition through Wnt/β-catenin pathway. BMC Cancer. 18(1099)2018.PubMed/NCBI View Article : Google Scholar
28	Yang Z, Feng X, Zhang P, Chen T, Qiu H, Zhou Z, Li G, Tao KX and Li Y: Clinicopathological features and prognosis of 276 cases of primary small (≤2 cm) gastric gastrointestinal stromal tumors: A multicenter data review. Surg Endosc. 33:2982–2990. 2018.PubMed/NCBI View Article : Google Scholar
29	Iwamuro M, Tsuzuki T, Ohya S, Okada H, Tanaka T, Hori K, Kita M, Kawano S, Kawahara Y and Yamamoto K: Ectopic pancreas in the stomach successfully resected by endoscopic submucosal dissection. Case Rep Med. 2015(147927)2015.PubMed/NCBI View Article : Google Scholar
30	Li J, Meng Y, Ye S, Wang P and Liu F: Usefulness of the thread-traction method in endoscopic full-thickness resection for gastric submucosal tumor: A comparative study. Surg Endosc. 33:2880–2885. 2019.PubMed/NCBI View Article : Google Scholar
31	Huang J, Xian X S, Huang LY, Zhang B, Wu CR and Jun Cui J: Endoscopic full-thickness resection for gastric gastrointestinal stromal tumor originating from the muscularis propria. Rev Assoc Med Bras (1992). 64:1002–1006. 2018.PubMed/NCBI View Article : Google Scholar
32	Wang Y, Li Y, Luo H and Yu H: Efficacy analysis of endoscopic submucosal excavation for gastric gastrointestinal stromal tumors. Zhonghua Wei Chang Wai Ke Za Zhi. 17:352–355. 2014.PubMed/NCBI(In Chinese).
33	Tan Y, Tan L, Lu J, Huo J and Liu D: Endoscopic resection of gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol. 2(115)2017.PubMed/NCBI View Article : Google Scholar
34	Wang H, Tan Y, Huo J and Liu D: Submucosal 1-tunnel endoscopic resection for treating upper gastrointestinal multiple submucosal tumor originating from the muscularis propria layer: A report of 12 cases. Medicine (Baltimore). 98(e14484)2019.PubMed/NCBI View Article : Google Scholar
35	Gluzman MI, Kashchenko VA, Karachun AM, Orlova RV, Nakatis IA, Pelipas IV, Vasiukova EL, Rykov IV, Petrova VV, Nepomniashchaia SL, et al: Technical success and short-term results of surgical treatment of gastrointestinal stromal tumors: An experience of three centers. Transl Gastroenterol Hepatol. 2(56)2017.PubMed/NCBI View Article : Google Scholar
36	Tsuji R, Komatsu S, Kumano T, Ohta A, Furuke H, Tanaka S, Imura K, Shimomura K, Ikeda J, Taniguchi F, et al: Laparoscopy and Endoscopy Cooperative Surgery (LECS)-Assisted open partial gastrectomy for a high-risk gastrointestinal stromal tumor. Gan To Kagaku Ryoho. 46:172–174. 2019.PubMed/NCBI(In Japanese).
37	Aisu Y, Yasukawa D, Kimura Y and Hori T: Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits. World J Gastrointest Oncol. 10:381–397. 2018.PubMed/NCBI View Article : Google Scholar
38	Ntourakis D and Mavrogenis G: Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status. World J Gastroenterol. 21:12482–12497. 2015.PubMed/NCBI View Article : Google Scholar