532 CLINICAL VALUES OF DENTAL FLOSS TRACTION ASSISTANCE IN ENDOSCOPIC FULL-THICKNESS RESECTION FOR SUBMUCOSAL TUMORS ORIGINATING FROM THE MUSCULARIS PROPRIA LAYER IN THE GASTRIC FUNDUS

With the development and maturation of endoscopic resection, endoscopic full-thickness resection (EFTR) derived from endoscopic submucosal dissection (ESD) is gradually accepted and promoted to treat submucosal tumors (SMTs) originating from muscularis propria (MP) lays. However, there are some difficulties when EFTR is applied in the treatment of muscularis propria lesions in gastric fundus. This study intends to explore whether EFTR can be more simple, safe and effective with the traction assistance of dental floss. From January to December in 2016, the clinical data of patients (trial group) with lesions from MP in gastric fundus undergoing EFTR with traction assistance of dental floss at Zhongshan Hospital, Fudan University were reviewed retrospectively. Control group was matched with trial group according to tumor size by one to one from January to December in 2015. The differences in tumor resection time, patient hospitalization time and complication rate were evaluated. EFTR with dental floss traction was performed as follows: During the stripping process, after removing the endoscope, an clip was tied on the tip of the dental floss, while the shorter side of the floss was cut to prevent it from affecting the field of view. The longer side of the floss was attached to the endoscope body side and was guided by an assistant.The endoscope was then reinserted, and the tumor was fastened by the clip. When the assistant pulled the dental floss, the tumor edge became clearly exposed. The tumor was then peeled away under direct visualization. There was no significant difference in the average age of the two groups with 24 cases respectively (58.7 ± 11.8 y vs 56.6 + 7.9 y, t = 0.663, P = 0.511). The statistic difference occurred when operative time was compared in two groups (10.8 + 2.8 min vs 19.0 ± 4.7 min, t = 7.298, P <0.05). There was no statistically significant difference in postoperative hospital stay time (3.2 + 0.5 d vs 3.2 + 0.5 d, t = 0.291, P = 0.772). In the trial group, there were 19 cases of gastrointestinal stromal tumors (both Group1) and 5 cases of leiomyoma. The control group have the same result. Two groups of patients were all not happened to postoperative delayed bleeding or perforation and other complications. First, dental floss traction could help expose the tumor boundaries, so that the operation field was clearer to simplify the operation process and significantly reduce the procedure time. Second, in the course of surgery, EFTR-assisted dental floss traction could better reveal the blood vessels or find bleeding blood vessels for prevention and early treatment of bleeding. Third, When the tumor was completely resected, dental floss could also prevent the tumors from falling into the abdominal cavity and help to remove the excised tumors.