Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video)
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Submucosal tunneling endoscopic resection (STER) can be adequately adopted as an effective treatment for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer at the esophagus and cardia. However, it has been seldom used for gastric SMTs. Our purpose was to evaluate the clinical impact of STER for gastric SMTs arising from the MP layer.
Thirty-two patients with gastric SMTs from the MP layer were retrospectively included. The main outcome measurements were complete resection rate, adverse events, local recurrence, and distant metastases during follow-up.
Of the 32 lesions, 12 were located in the gastric corpus close to the cardia, 3 in the gastric fundus close to the cardia, 6 in the lesser curvature of the gastric corpus, and 11 in the greater curvature of the gastric antrum. STER was successfully performed in all patients with en bloc resection of tumors. The mean tumor size was 2.3 cm (range 1.0–5.0 cm). The complete resection rate was 100 %. The operation time ranged from 25 to 125 min (mean 51.8 min). All complications related to STER were successfully managed with conservative treatments. Local recurrence or distant metastasis did not occur during a follow-up period of 6–32 months.
STER is a safe and effective therapeutic strategy for eligible gastric SMTs originating from the MP layer. Submucosal tunneling in the stomach may be more challenging than that in the esophagus, but does not increase procedure-related adverse events or prevent successful STER for eligible gastric SMTs.
KeywordsSubmucosal tunneling endoscopic resection Gastric submucosal tumor Muscularis propria
This study was supported by the Grants from the Major Project of Shanghai Municipal Science and Technology Committee (14441901500), National Natural Science Foundation of China (81302098, 81370588 and 81201902), and Natural Science Foundation of Shanghai (13ZR1452300).
Drs. Li QL, Chen WF, Zhang C, Hu JW, Zhou PH, Zhang YQ, Zhong YS, Yao LQ, and Xu MD have no conflicts of interest or financial ties to disclose.
Video 1: An example of the submucosal tunneling endoscopic resection (STER) procedure for a submucosal tumor in the gastric antrum. Supplementary material 1 (WMV 42834 kb)