Implementation of endoscopic full-thickness resection for gastric submucosal tumor into Japanese clinical practice Young Award

The development of ESD advanced minimally invasive treatment in the gastrointestinal (GI) tract. Currently, with improvement of technique for muscle defect repair, working fields of tumor resection by peroral endoscopy is not restricted inside the GI lumen. Endoscopic full thickness resection (EFTR) is established as one of treatment methods for gastric submucosal tumor (SMT) in China. In order to adopt EFTR into Japanese clinical practice, the following strategy was devised: 1) observation of real procedures in China, 2) local ethics committee approval, 3) confirmation of feasibility in our past experience, 4) advanced medical care coverage, 5) conduction of a prospective clinical study to validate the feasibility. From January 2018 to February 2021, 19 patients with 20 gastric SMT (M:F=8:11, mean age 64 years, median tumor size 20.5 mm) underwent EFTR in our hospital. All procedures were done in an operation room under general anesthesia. All lesions were removed en bloc (mean procedure time 63 min). Gastric wall was completely removed in 14 lesions, and 4 required paracentesis for pneumoperitoneum. No adverse event that required surgical intervention occurred. Histological examination showed 15 GISTs, 2 shwannoma, 1 leiomyoma, 1 fibroma, and 1 Glomus tumor．The patients were kept fasting for 2-5 days, and discharged after mean days of 6.5. A multicenter prospective study is ongoing among five institutions.