Abstract
Background
This prospective study was designed to evaluate the safety and efficacy of submucosal tunneling endoscopic resection (STER) for small (≤3 cm) upper gastrointestinal (GI) subepithelial tumors (SETs) originating from the muscularis propria (MP) layer.
Methods
Between August 2011 and February 2013, a total of 85 patients with upper GI SETs originating from the MP layer were treated with STER. The key steps were as follows: (1) locating the tumor by injection of methylene blue or indigo carmine and then creating a submucosal tunnel from 5 cm above the tumor between the submucosal and muscular layers; (2) resecting the tumor by endoscopic resection techniques; (3) closing the mucosal incision site with several clips after the tumor is removed.
Results
Of the 85 SETs, 60 were located in the esophagus, 16 in the cardia, and 9 in the stomach. STER was successfully performed in all cases (success rate: 100 %). The mean tumor size was 19.2 mm. The mean procedure time was 57.2 min. The average hospital stay after the procedure was 5.9 days. Pathological diagnosis of the tumors were leiomyoma (65/85), gastrointestinal stromal tumor (GIST) (19/85), and calcifying fibrous tumor (1/85). During the procedure, eight patients developed pneumothorax, subcutaneous emphysema, and/or pneumoperitoneum. These patients recovered after conservative treatment. The rate of all complications was significantly higher for lesions originating in the deeper MP layer (70 %) than in the superficial MP layer (1.3 %; p < 0.001). The total complication rate for different histological diagnoses was also significantly different (26.3 % for GISTs, 4.6 % for leiomyomas, 0 % for calcifying fibrous tumors, p < 0.05). No residual or recurrent tumors were detected during the follow-up period (median: 8 months).
Conclusions
Submucosal tunneling endoscopic resection appears to be a feasible, safe, and effective procedure for treatment of small (≤3 cm) upper GI SETs originating from the MP layer.
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References
Sakamoto H, Kitano M, Kudo M (2010) Diagnosis of subepithelial tumors in the upper gastrointestinal tract by endoscopic ultrasonography. World J Radiol 2:289–297
Białek A et al (2012) Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc 75:276–286
Akahoshi K et al (2007) Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J Gastroenterol 13:2077–2082
Hoda KM, Rodriguez SA, Faigel DO (2009) EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc 69:1218–1223
Melstrom LG et al (2012) Laparoscopic versus open resection of gastric gastrointestinal stromal tumors. Am J Clin Oncol 35:451–454
De Vogelaere K et al (2012) Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size. Surg Endosc 26:2339–2345
Li QL et al (2012) Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc 75:1153–1158
Zhang Y et al (2013) Endoscopic muscularis excavation for subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer. Dig Dis Sci 58:1335–1340
Khashab MA et al (2013) Novel technique for submucosal tunneling and endoscopic resection of submucosal tumors (with video). Gastrointest Endosc 77:646–648
Xu MD et al (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75:195–199
Ye LP et al (2013) Submucosal tunnelling endoscopic resection for the treatment of esophageal submucosal tumours originating from the muscularis propria layer: an analysis of 15 cases. Dig Liver Dis 45:119–123
Mukai S et al (2012) Analysis of delayed bleeding after endoscopic submucosal dissection for gastric epithelial neoplasms. Gastroenterol Res Pract 2012:875323
Lee TH et al (2010) Appropriate indications for endoscopic submucosal dissection of early gastric cancer according to tumor size and histologic type. Gastrointest Endosc 71:920–926
Demetri GD et al (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw 8(Suppl 2):S1–S41 quiz S42–S44
Probst A et al (2009) Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in the gastrointestinal tract. Clin Gastroenterol Hepatol 7:149–155
Jeong ID et al (2011) Endoscopic enucleation for gastric subepithelial tumors originating in the muscularis propria layer. Surg Endosc 25:468–474
von Delius S et al (2008) Comparison of transgastric access techniques for natural orifice transluminal endoscopic surgery. Gastrointest Endosc 68:940–947
Disclosures
Li-Ping Ye, Yu Zhang, Xin-Li Mao, Lin-hong Zhu, and Ji-Ya Chen have no conflicts of interest or financial ties to disclose.
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Ye, LP., Zhang, Y., Mao, XL. et al. Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc 28, 524–530 (2014). https://doi.org/10.1007/s00464-013-3197-8
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DOI: https://doi.org/10.1007/s00464-013-3197-8