Patient Information
A total of 112 cases diagnosed with STMF and treated in the Fourth Affiliated Hospital of China Medical University from 2016 to 2020 were evaluated. There were 10 patients qualified for the 6TGS technique (2 males and 8 females), aged 57.6 ± 10.07 (46–78), with a lesion diameter of 1.34 ± 1.63 (0.5-5.0) cm. 6TGS was successfully performed in 7 patients (70%), failed in 3 patients (30%). Endoscopic treatment methods after successful 6TGS: EFTR: 5 cases; ESD: 2 cases. (See Table 1).
Table 1
Items
|
Details
|
Number of cases
|
Age
|
57.6 ± 10.07 (46–78) years
|
10
|
Sex
|
Male
|
2
|
|
Female
|
8
|
Lesion diameter
|
1.34 ± 1.63(0.5-5.0) cm
|
|
Location
|
Middle of the fornix
|
1
|
|
Great curved side of anterior wall of the fornix
|
4
|
|
Posterior wall of fundus
|
1
|
|
Greater curvature side of fundus
|
1
|
|
Greater curvature side of middle of the fornix
|
3
|
Endoscopic surgery method after successful 6TGS
|
ESD
|
2
|
|
EFTR
|
5
|
Successful 6TGS
|
7/10
|
70%
|
Surgical duration:
|
83.86 ± 46.74 (47–182) min
|
|
Complications:
|
None observed
|
0
|
Length of hospitalization
|
7.29 ± 0.49 (7–8) days
|
|
The results of 6TGS application:
After 6TGS was used in 10 patients, the tip of the gastroscope could access the location just below the gastric cardia in 7 patients. All angles of the fundus of the stomach were operable in all 7 patients. Using 6TGS, there was no need for paradoxical movement; it was much easier to access the lesion and observe.
The Suitable location for 6TGS:
6TGS allowed clear visualization of the lesions in all the fundus area and the mucosa just below the gastric cardia.
Operating characteristics of 6TGS:
In this study, 6TGS was mainly used for submucosal injection and lesion dissection during endoscopic treatment of STMF. Post-resection trauma suturing was performed in a conventional endoscopy progression.
Using 6TGS, we were able to access and visualize the following area in the lesion: the edge close to the pylorus (7/7), the edge close to gastric cardia (5/7), and the left and right edges (7/7). When the lesion was large, it was difficult for the gastroscopy body to cross the lesion to observe the lesion’s edge at the gastric cardia.
As for the Operational Performance Evaluation of the 6TGS technique, it was very accessible to navigate the tip of the gastroscope tip left or right using the small adjusting knobs; however, moving the gastroscope forward and backward was still of moderate difficulty. The gastroscope’s body makes a “6”-turn along the gastric wall, which made the gastroscopy tip stable at every angle due to the support of the gastric wall. The gastroscope was stable at every angle without the need for an assistant to support the endoscope, and the operator could manually adjust the devices in the instrument channel to complete a variety of complex adjustments, cutting, and hemostasis. Since the gastroscopy tip could access the lesion’s edges with stable visualization, the details of each layer below the mucosa and above the lesion could be clearly observed; however, water accumulation in the lesion area had certain interference. The stability of the gastroscope body increased the forward puncture ability of the injection needle during submucosal injection. The 6TGS technique also allowed the gastroscopy body to form a small injection inclination angle with the gastric wall, making it easier to enter the submucosal space. (See Table 2.)
Table 2
Evaluation of 6TGS operating characteristics
Items
|
Very good
|
Good
|
Fair
|
Poor
|
The left and right movement ability
|
|
7/7
|
|
|
Push forward and pull back ability
|
|
|
7/7
|
|
Ability to stay in place
|
7/7
|
|
|
|
Visualization ability
|
6/7
|
1/7
|
|
|
Submucosal injection result
|
6/7
|
1/7
|
|
|
The dissector can be parallel to the muscularis propria forming a good inclination angle during the dissection of the STMF except for tumors at the posterior wall of the fundus. There was some resistance while progressing the instruments in the instrument channel using the 6TGS technique; however, this defect is the same as in the traditional U-turn.
Factors affecting the success of 6TGS.
Surgeries were performed while the patients were in the supine position under general anesthesia with endotracheal intubation. In 3 patients, 6TGS could not be completed due to the fundus morphology of the lesion. 6TGS was successfully performed in 7 cases, in which the visualization was air-dependent, and the gastric inflation was successful with less air volume. Notably, 6TGS could not be completed with more air volume in the stomach.
Postoperative and follow-up results:
The operation duration using the 6TGS technique was 83.86 ± 46.74 (47–182) min, and the hospital stay was 7.29 ± 0.49 (7–8) days. Postoperative histopathological evaluation revealed stromal tumors. No complications were observed, and the patients recovered well after the operation. During the postoperative follow-ups, there was no residual or recurrent tumor, metastasis, or death.