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Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation

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Abstract

Background and aims

Submucosal tunneling endoscopic resection (STER) is increasingly used for the treatment of submucosal tumors (SMTs) originating from the muscularis propria layer; however, endoscopic submucosal excavation (ESE) is still performed in many hospitals for its low-skill and experience requirements. This study aimed to compare STER with ESE for cardial SMTs.

Methods

From March 2013 to February 2017, patients with cardial SMTs undergoing STER (n = 47) and ESE (n = 40) were retrospectively assessed. Clinicopathological, endoscopic, and complication data were compared between STER and ESE groups.

Results

The 87 enrolled patients included 31 females and 56 males, aged 48.2 ± 9.8 years. Mean tumor size was 22.0 mm (range 5.0–80.0 mm) as evaluated by pathology. Demographic and lesion features were similar in both groups. Despite similar hospital stay duration and cost, ESE was superior to STER with reduced operation time (34 vs. 46 min, P = 0.013) and less clips required (3 vs. 5, P = 0.000). En bloc resection rates, complete resection rates, hospital stay duration, cost, complications, and hemoglobin levels were similar in both groups. Irregular-shaped SMTs were more likely to achieve piecemeal resection in both STER and ESE groups (all P < 0.05). Meanwhile, the piecemeal resection rate was significantly higher for larger tumors in the STER group.

Conclusion

Compared with ESE, STER does not show overt advantages for cardial SMTs. However, ESE is superior to STER for reduced operation time. Irregular tumor shape seems to be a risk factor for piecemeal resection in both STER and ESE.

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Acknowledgements

This study was supported by research grants from two Chinese PLA General Hospital Clinical Researches (2012FC-TSYS-3035 and YS201404).

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Author notes

  1. Chen Du and Ningli Chai have contributed equally to this study.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China

    Chen Du, Ningli Chai, Enqiang Linghu, Ying Gao, Zhenjuan Li, Longsong Li, Yaqi Zhai, Zhongsheng Lu, Jiangyun Meng & Ping Tang

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  1. Chen Du
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  2. Ningli Chai
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  3. Enqiang Linghu
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Correspondence to Enqiang Linghu.

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Disclosures

Drs. Chen Du, Ningli Chai, Enqiang Linghu, Ying Gao, Zhenjuan Li, Longsong Li, Yaqi Zhai, Zhongsheng Lu, Jiangyun Meng, and Ping Tang have no conflicts of interest or financial ties to disclose.

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Du, C., Chai, N., Linghu, E. et al. Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation. Surg Endosc 32, 4543–4551 (2018). https://doi.org/10.1007/s00464-018-6206-0

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