Digestive Diseases and Sciences

, Volume 58, Issue 5, pp 1335–1340

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

  • Yu Zhang
  • Li-ping Ye
  • Lin-hong Zhu
  • Xian-bin Zhou
  • Xin-li Mao
  • Jin-xiu Ding
Original Article

DOI: 10.1007/s10620-012-2487-7

Cite this article as:
Zhang, Y., Ye, L., Zhu, L. et al. Dig Dis Sci (2013) 58: 1335. doi:10.1007/s10620-012-2487-7

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 junctionSubepithelial tumorMuscularis propria layerEndoscopic excavation

Supplementary material

View video

Video 1. Example of the endoscopic muscularis excavation procedure for subepithelial tumor of the esophagogastric junction originating from the muscularis propria layer a in a 51-year-old male (MP4 31181 kb)

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Yu Zhang
    • 1
  • Li-ping Ye
    • 1
  • Lin-hong Zhu
    • 2
  • Xian-bin Zhou
    • 1
  • Xin-li Mao
    • 1
  • Jin-xiu Ding
    • 1
  1. 1.Department of Gastroenterology, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical CollegeLinhaiChina
  2. 2.Admin Office, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical CollegeLinhaiChina