Factors that predict the technical difficulty during endoscopic full-thickness resection of a gastric submucosal tumor.

BACKGROUND AND AIM: endoscopic full-thickness resection (EFTR) is widely accepted for the treatment of gastric submucosal tumors (SMTs). However, technical difficulties sometimes occur. The aim of the present study was to assess the safety and efficacy of EFTR for gastric SMTs and to explore risk factors for technical difficulty.

METHODS

the clinical data of patients who received EFTR for gastric SMTs was retrospectively collected from April 2011 to September 2019. Efficacy was defined as an en bloc resection. Difficult EFTR was defined as a procedure time ≥ 120 minutes and/or the occurrence of major adverse events, such as major bleeding, abdominal pain or peritonitis. Finally, risk factors for technical difficulty of EFTR such as gender, age, tumor location, size, symptomatic, regular, outgrowth, operator experience and pathology were analyzed in a univariate and multivariate analysis.

RESULTS

one hundred SMTs were removed by EFTR. The average surgery time was 75.73 ± 45.9 (range: 20-250) minutes and the average tumor size was 16.23 ± 7.73 (range: 6-40) mm. With regard to efficacy, en bloc resection was achieved in 98 cases (98 %). A total of ten patients (9.9 %) had complications, namely two intra-operative bleeding, one delayed bleeding and seven patients had abdominal pain (overt peritonitis). EFTR was ceased in one patient due to massive intra-operative bleeding and conversion to laparoscopic surgery was necessary. One patient required laparoscopic surgery due to delayed bleeding, and other complications were resolved with a conservative treatment. A total of 18 cases (17.8 %) encountered a difficult EFTR: tumor size ≥ 3 cm (p = 0.008) and location at the gastric corpus (p = 0.007) were risk factors for a difficult EFTR according to the logistic analysis.

CONCLUSION

EFTR is safe and effective for the treatment of gastric SMTs. Tumor size of ≥ 3 cm and location at the gastric corpus are risk factors for a difficult EFTR.