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Faisal Inayat,Aysha Aslam,Mathew D. Grunwald,Qulsoom Hussain,Abu Hurairah,Shahzad Iqbal 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arisingfrom the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasinglydetected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advancedtechnique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a numberof methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem isappropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge,this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic optionin patients with gastric GISTs.
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Waqas Ullah,Maryam Mukhtar,Hafez Mohammad Abdullah,Mamoon Ur Rashid,Asrar Ahmad,Abu Hurairah,Usman Sarwar,Vincent M. Figueredo 대한심장학회 2019 Korean Circulation Journal Vol.49 No.5
The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ2=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
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