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Background: This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria. Methods: Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips. Results: EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60-145) min. The mean resected lesion size was 2.8 (range, 1.2-4.5) cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8 months; range, 6-24 months). Conclusions: EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) is a new, widely accepted method for the treatment of early gastric cancer and was developed to increase the en bloc resection rate. This study aimed to evaluate the efficacy and safety of ESD compared with conventional endoscopic mucosal resection (EMR) for small rectal carcinoid tumors. Methods: A retrospective study was carried out that included 43 patients with small rectal carcinoid tumors (<10 mm). The cohort comprised two groups: Group A ( N = 23) underwent conventional EMR from January 2004 to August 2005, while group B ( N = 20) underwent ESD with needle-knife from September 2005 to December 2006. The rate of curative en bloc resection, the procedure time, and the incidence of complications were evaluated. Results: The en bloc resection rate and the rate of completeness of resection of group B were higher than those of group A (100 vs. 87%, 100 vs . 52.5%, respectively). The average operation time required for resection was significantly longer in group B (28.4 ± 17.2 min) compared with group A (12.3 ± 15.4 min) ( p < 0.05). None of the patients had immediate or delayed bleeding during the procedure. Perforation occurred in one case of group B and the patient recovered after several days of conservative treatment. Three patients had local recurrence after EMR, while no patient experienced recurrence after ESD. Conclusion: ESD, compared with conventional EMR, increased en bloc and histologically complete resection rates and may reduce local recurrence rate for small rectal carcinoid tumors. Increased operation time and complication risks with ESD remain problematic. Further technique and investigation are required to confirm the safety and to assess the long-term prognosis of ESD. [ABSTRACT FROM AUTHOR]

The ratio of serum gamma-glutamyl transferase (GGT) to alanine aminotransferase (ALT) is a parameter for assessing responses to antiviral therapies. The relationship between the prognosis of hepatitis B-associated hepatocellular carcinoma (HCC) and preoperative GGT/ALT is studied in hepatectomized Child-Pugh A patients. Two hundred and nineteen patients with hepatitis B virus-related HCC were included. Serum ALT and GGT levels were examined preoperatively and the GGT/ALT ratios were calculated. Their prognostic capabilities were evaluated by Cox-regression model. As dichotomized variables, GGT and ALT were distributed unequally ( P < 0.001). Most patients had high levels of GGT ( n = 110) but low levels of ALT ( n = 185). ALT displayed no relation to recurrence or survival, while GGT was independently associated with survival ( P = 0.002). The GGT/ALT ratio could predict survival precisely either in a continuous or dichotomized fashion ( P < 0.001 and 0.001, respectively), and also related to recurrence when dichotomized ( P = 0.002). Additionally, high GGT/ALT ratio was associated with high early recurrence rates, more recurrence-related deaths and various aggressive tumor characteristics such as larger tumor size, vascular invasion, poor encapsulation and advanced BCLC stage. In further stratified analyses, this ratio could discriminate the outcomes of patients with high- or low-α-fetoprotein level. The elevated GGT/ALT ratio was a promising predictor for poor prognosis of Child-Pugh A HCC patients after operation mainly through its tight relevance to the primary tumor burden. [ABSTRACT FROM AUTHOR]