Endoscopic Full‐thickness Resection for Gastric Submucosal Tumor: A Technical Analysis Study (With Video)

Endoscopic full-thickness resection (EFTR) is an effective treatment method for gastric submucosal tumors (SMTs). We aimed to perform a technical analysis of EFTR in gastric SMT and compare it with the outcome parameters. Sixty-one gastric SMTs from 60 patients were resected using EFTR. The indication criteria: size, 11-30 mm, connection to the muscularis propria on endoscopic ultrasonography, intraluminal growth type, no ulceration, and histologically evident or clinically suspicious gastrointestinal stromal tumors (GISTs). The following technical improvements were introduced during the study Periods 1-3: routine use of clip-line traction (Periods 1-3); use of a plastic bag retriever (Periods 2-3); adaptation of the reopenable clip over-the-line method (ROLM, Period 3); implementation of no-touch EFTR (Period 3); and elimination of submucosal injection (Period 3). The endoscopic complete resection rate was 100%, with a similar tumor resection time (median, 50 min) throughout the periods. Specimen damage was less frequent after using the plastic bag retriever in Periods 2 and 3 (p = 0.001). In Period 3, ROLM required longer full-thickness defect closure time (39 min, p = 0.011), but it provided secure closure and shortened the fasting days (p = 0.010). Histological diagnoses included 38 GISTs, 14 leiomyomas, and nine other pathologies. In Period 3, the implementation of no-touch EFTR increased the resected specimen size (33 mm, p = 0.010) and improved the histological complete (R0) resection rate of the GISTs (13/13, 100%, p = 0.017). Several technical improvements significantly improved the outcomes of EFTR for gastric SMTs, warranting the external validation of this technique.