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Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria

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Abstract

Background and aims

Based on our experience with endoscopic submucosal dissection (ESD) and new endoscopic techniques for endoscopic closure of iatrogenic upper gastrointestinal (upper-GI) perforations, we developed methods to remove upper-GI subepithelial tumors (SETs) originating from the muscularis propria by endoscopic muscularis dissection (EMD). The aim of this study is to evaluate the clinical feasibility and safety of EMD.

Methods

31 patients with upper-GI SETs originating from the muscularis propria were treated by EMD. The EMD differed from ESD in (1) precutting the overlying mucosa above the lesion by using snare or longitudinal incision instead of circumferential incision, (2) dissecting the complete tumors away from submucosal and muscularis propria tissue by electrical dissection combined with blunt dissection, and (3) closing the wound with clips. Perforations occurring during dissection were closed by endoscopic methods.

Results

30 of 31 tumors were resected completely (96.8 %). One esophageal lesion was resected partially because of severe adhesions with surrounding tissue. Mean resected tumor size was 22.1 mm × 15.5 mm, and mean operation time was 76.8 min (range 15–330 min). Histological diagnosis was gastrointestinal stromal tumor (GIST) in 16 lesions [6 esophageal, 3 cardial, 7 gastric; 6 very low risk and 10 low risk according to the National Institutes of Health (NIH) risk classification] and leiomyoma in 15 lesions (8 esophageal, 4 cardial, 3 gastric). No patient developed delayed hemorrhage. Perforation occurred in four patients (12.9 %), all of which were managed successfully by endoscopic techniques. The mean follow-up time was 17.7 months (range 7–35 months). Follow-up found no tumor recurrence in any patient.

Conclusions

In this early experience, EMD appears to be a feasible and minimally invasive treatment for some patients with upper-GI SETs originating from the muscularis propria. Although there is a higher risk of perforation than with ESD, this will improve with extended practice, and perforations have become manageable endoscopically.

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Disclosures

Authors Bing-Rong Liu, Ji-Tao Song, Bo Qu, Ji-Feng Wen, Ji-Bin Yin, and Wei Liu have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, People’s Republic of China

    Bing-Rong Liu, Ji-Tao Song, Bo Qu, Ji-Feng Wen, Ji-Bin Yin & Wei Liu

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  1. Bing-Rong Liu
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  2. Ji-Tao Song
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Correspondence to Bing-Rong Liu.

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Liu, BR., Song, JT., Qu, B. et al. Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria. Surg Endosc 26, 3141–3148 (2012). https://doi.org/10.1007/s00464-012-2305-5

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  • DOI: https://doi.org/10.1007/s00464-012-2305-5

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