Endoscopic resection of gastrointestinal submucosal lesions: a comparison between strip biopsy and aspiration lumpectomy☆,☆☆,★
Section snippets
Study design, setting, and end points
This comparative study was a controlled trial with nonrandomized concurrent controls (“nonrandomized surgeon” design7, 8). The patients were randomly allocated to two groups of surgeons, who then performed their operation of choice. Since both groups of endoscopic surgeons were thoroughly familiar with their method of choice, exclusion for technical reasons was unnecessary. No surgeon had to learn or relearn an endoscopic technique, and thus there were no initial inferior results. The relative
RESULTS
Table 1 lists the clinical characteristics of the patients treated by endoscopic resection. The patients included 37 men and 40 women, aged 15 to 80 years, with an overall mean age of 56 years. The tumor localization was statistically significant (p < 0.001) because of the small number of esophageal lesions in the strip biopsy group. All of the 13 colonic lesions were located in the rectum except for one case of a lipoma removed by strip biopsy in the ascending colon. The lesions ranged in size
DISCUSSION
Submucosal lesions should preferably be diagnosed and treated by endoscopic methods, since these are less invasive than surgical laparotomy. Endoscopic submucosal biopsy only allows diagnoses, without any eradication of the lesion. The “button-hole biopsy” technique2 was an attempt to improve these methods by allowing the sampling of histologic specimens from an area previously exposed by means of an electrosurgical snare or an ethanol injection. Aspiration cytology,13 giant biopsy,14 and
Acknowledgements
The authors thank Bruce Symons for his helpful suggestions regarding the manuscript.
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Cited by (61)
Clinical outcomes of cap-assisted endoscopic resection for small rectal subepithelial tumors
2021, Gastroenterologia y HepatologiaCitation Excerpt :Hence it cannot be applied in preliminary hospitals. In 1996, Kajiyama et al.10 reported 38 cases in which a transparent cap was used to remove small submucosal GI tumors, with few adverse events. The tumor was first aspirated into the cap, grasped at its base with a snare, removed by electrocautery and then retrieved by aspirating into the cap.
Endoscopic ultrasound-guided tissue acquisition of subepithelial masses
2018, Techniques in Gastrointestinal EndoscopyCitation Excerpt :Gastric perforation was not uncommon, seen in nearly 15% of patients, and bleeding was also reported in 5%. Modifications of traditional endoscopic mucosal resection have been reported including cap assisted and ligation devices, with similarly impressive resection rates and DY, but unfortunately also with significant complication rates [55,56]. The endoscopic tunneling technique, while initially reported for per oral endoscopic myotomy, was first reported to be successful for resection of SEM in the English literature in 2012 by Xu et al [57], Gong et al [58], and Inoue et al [59].
Giant gastric lipoma presenting as GI bleed: Enucleation or Resection?
2017, International Journal of Surgery Case ReportsCitation Excerpt :Asymptomatic incidental lipomas usually only require observation. Small symptomatic lesions around 2 cm in size can be successfully treated with endoscopic management using techniques such as aspiration lumpectomy or strip biopsy [17]. Larger lipomas, 4 cm or greater, can be removed endoscopically with the unroofing technique [18].
Expanding indications for ESD: Submucosal disease (SMT/Carcinoid Tumors)
2014, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :In the “pre-ESD” era, however, endoscopic en bloc local resection of SMT was technically challenging with relatively higher risk of complications. These procedures were done only by some endoscopists in the manner of modified endoscopic mucosal resection (EMR) to obtain histologic assessment of the tumor.13,14 Through the emergence of ESD, the possibility of en bloc resection increased, even for SMTs.15–25
Endoscopic Ultrasonography-Guided Diagnosis of Subepithelial Tumors
2012, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :ESMR adapts a variety of endoscopic mucosal resection techniques to removing lesions from the submucosa (third layer). ESMR involves raising the lesion away from the fourth layer, the muscularis propria, either by injection of saline solution (strip biopsy) or suction of the lesion into a cap fitted to the endoscope (aspiration lumpectomy), followed by electrosurgical snare resection.7,64,70,71 Subepithelial lesions that are confined to layers 1 to 3 and up to 20 mm in size are amenable to safe resection.7,64,72
Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection{A figure is presented}
2006, Gastrointestinal EndoscopyCitation Excerpt :In ESMR-C a transparent plastic cylinder is placed on the end of an endoscope into which the target mucosal lesion is suctioned and then resected with an electrosurgical snare. Case reports and series have described the use of ESMR in the diagnosis and resection of subepithelial tumors that are benign or of low malignant potential.4-6,14-19 Kojima et al5 evaluated the diagnostic utility of endoscopic resection in 54 patients with subepithelial lesions involving the submucosa and muscularis propria.
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From the First Department of Internal Medicine, and the First Department of Surgery, Kyoto University, Kyoto, Japan; and the Department of Gastroenterology, Tenri Hospital, Nara, Japan.
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Reprint requests: Toru Kajiyama, MD, First Department of Internal Medicine, Kyoto University, Sakyo Ward, Kyoto, 606-01, Japan.
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