Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study
Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumor...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2015/618756 |
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| author | Field F. Willingham Paul Reynolds Melinda Lewis Andrew Ross Shishir K. Maithel Flavio G. Rocha |
| author_facet | Field F. Willingham Paul Reynolds Melinda Lewis Andrew Ross Shishir K. Maithel Flavio G. Rocha |
| author_sort | Field F. Willingham |
| collection | DOAJ |
| description | Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors. Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management. Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens. Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection. |
| format | Article |
| id | doaj-art-e5690b7e371249e4a3e315d5db92fafe |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-e5690b7e371249e4a3e315d5db92fafe2025-02-03T06:13:39ZengWileyGastroenterology Research and Practice1687-61211687-630X2015-01-01201510.1155/2015/618756618756Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical StudyField F. Willingham0Paul Reynolds1Melinda Lewis2Andrew Ross3Shishir K. Maithel4Flavio G. Rocha5Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USADivision of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USADivision of Cytology, Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USASection of Gastroenterology, Department of Medicine, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, USADivision of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USASection of General, Thoracic and Vascular Surgery, Department of Surgery, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, USABackground. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors. Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management. Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens. Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.http://dx.doi.org/10.1155/2015/618756 |
| spellingShingle | Field F. Willingham Paul Reynolds Melinda Lewis Andrew Ross Shishir K. Maithel Flavio G. Rocha Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study Gastroenterology Research and Practice |
| title | Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study |
| title_full | Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study |
| title_fullStr | Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study |
| title_full_unstemmed | Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study |
| title_short | Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study |
| title_sort | hybrid push pull endoscopic and laparoscopic full thickness resection for the minimally invasive management of gastrointestinal stromal tumors a pilot clinical study |
| url | http://dx.doi.org/10.1155/2015/618756 |
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