Original Article

Digestive Diseases and Sciences

, Volume 58, Issue 5, pp 1335-1340

First online:

Endoscopic Muscularis Excavation for Subepithelial Tumors of the Esophagogastric Junction Originating from the Muscularis Propria Layer

  • Yu ZhangAffiliated withDepartment of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College
  • , Li-ping YeAffiliated withDepartment of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College Email author 
  • , Lin-hong ZhuAffiliated withAdmin Office, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College
  • , Xian-bin ZhouAffiliated withDepartment of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College
  • , Xin-li MaoAffiliated withDepartment of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College
  • , Jin-xiu DingAffiliated withDepartment of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College

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Abstract

Background

Because of complicating anatomic factors, endoscopic submucosal dissection is seldom performed in subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer.

Aim

This study was designed to evaluate the feasibility of endoscopic muscularis excavation for treating subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer.

Methods

Between December 2008 and December 2011, 68 patients with subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer were treated with endoscopic muscularis excavation. Key steps of the procedure included the following: (1) injecting a mixture solution into the submucosal layer after making several dots around the tumor; (2) making a cross incision of the overlying mucosa, and excavating the tumor from the muscularis propria layer; (3) closing the artificial ulcer with clips after tumor removal.

Results

The mean tumor size was 16.2 mm (range 7–35 mm). Endoscopic muscularis excavation was successfully performed in 65 out of 68 cases (success rate 95.6 %). Pathological diagnosis of these tumors included leiomyoma (39 out of 68) and gastrointestinal stromal tumor (29 out of 68). Perforation occurred in seven patients (10.3 %). No massive bleeding or delayed bleeding occurred. The median follow-up period after the procedure was 23 months (range 6–42 months). No residual or recurrent tumor was detected and no stricture occurred in patients during the follow-up period.

Conclusions

Endoscopic muscularis excavation is a safe, effective and feasible procedure for providing accurate histopathologic evaluation and curative treatment for subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer.

Keywords

Esophagogastric junction Subepithelial tumor Muscularis propria layer Endoscopic excavation