• Journal of Digestive Cancer Research
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• 제10권1호
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• pp.16-21
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• 2022

Diagnosis of gastric subepithelial tumors (SETs) is sometimes difficult with conventional endoscopy or tissue sampling with standard biopsy, so non-invasive imaging modalities such as endoscopic ultrasound (EUS) and computed tomography are used to evaluate the characteristics of SETs features (size, location, originating layer, echogenicity, shape). However imaging modalities alone is not able to distinguish among all types of SETs, so histology is the gold standard for obtaining the final diagnosis. For tissue sampling, mucosal cutting biopsy and mucosal incision-assisted biopsy and EUS-guided fine-needle aspiration or biopsy (EUS-FNA or EUS-FNB) is commonly recommended. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are used for resection of SETs involving the mucosal and superficial submucosal layers, could not treat adequately and safely the SETs involving the deep mucosa and muscularis propria. Submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR) is used as a therapeutic option for the treatment of SETs with the development of reliable endoscopic closure techniques and tools.

• Journal of Gastric Cancer
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• 제13권4호
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• pp.199-206
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• 2013

Since the first transgastric natural orifice transluminal endoscopic surgery was described, various applications and modified procedures have been investigated. Transgastric natural orifice transluminal endoscopic surgery for periotoneoscopy, cholecystectomy, and appendectomy all seem viable in humans, but additional studies are required to demonstrate their benefits and roles in clinical practice. The submucosal tunneling method enhances the safety of peritoneal access and gastric closure and minimizes the risk of intraperitoneal leakage of gastric air and juice. Submucosal tunneling involves submucosal tumor resection and peroral endoscopic myotomy. Peroral endoscopic myotomy is a safe and effective treatment option for achalasia, and the most promising natural orifice transluminal endoscopic surgery procedure. Endoscopic full-thickness resection is a rapidly developing natural orifice transluminal endoscopic surgery procedure for the upper gastrointestinal tract and can be performed with a hybrid natural orifice transluminal endoscopic surgery technique (combining a laparoscopic approach) to overcome some limitations of pure natural orifice transluminal endoscopic surgery. Studies to identify the most appropriate role of endoscopic full-thickness resection are anticipated. In this article, I review the procedures of natural orifice transluminal endoscopic surgery associated with the upper gastrointestinal tract.

• Journal of Gastric Cancer
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• 제24권1호
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• pp.122-134
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• 2024

Most gastric subepithelial tumors (SETs) are asymptomatic and are often incidentally discovered during endoscopic procedures conducted for unrelated reasons. Although surveillance is sufficient for the majority of gastric SETs, certain cases necessitate proactive management. Laparoscopic wedge resection, although a viable treatment option, has its limitations, particularly in cases where SETs (especially those with intraluminal growth) are not visualized on the peritoneal side. Recent advances in endoscopic instruments and technology have paved the way for the feasibility of endoscopic resection of SETs. Several promising endoscopic techniques have emerged for gastric SET resection, including submucosal tunneling endoscopic resection, endoscopic full-thickness resection (EFTR), laparoscopic and endoscopic cooperative surgery (LECS), and non-exposure EFTR (non-exposed endoscopic wall-inversion surgery and non-exposure simple suturing EFTR). This study aimed to discuss the indications, methods, and outcomes of endoscopic therapy for gastric SETs. In addition, a simplified diagram of the category of SETs according to the therapeutic indications and an algorithm for the endoscopic management of SET is suggested.