Acta Endoscopica

, Volume 46, Issue 6, pp 361–367 | Cite as

Résection endoscopique des tumeurs sous-muqueuses gastriques de petite taille

  • G. Perrod
  • G. Rahmi
  • E. Samaha
  • A. Vienne
  • H. Benosman
  • C. Savale
  • S. Khater
  • J.-B. Danset
  • A.-L. Pointet
  • L. Abbes
  • G. Malamut
  • B. Landi
  • C. Cellier
Mise au Point / Update
  • 42 Downloads

Résumé

Les tumeurs sous-muqueuses (TSM) de l’estomac sont des lésions fréquentes de découverte souvent fortuite. La plupart des TSM sont asymptomatiques et d’évolution bénigne, telles que les lipomes, les léiomyomes, les schwannomes, les pancréas aberrants. Certaines TSM gastriques ont un potentiel de malignité, notamment celles développées à partir de la musculeuse comme les gastrointestinal stromal tumor et les tumeurs neuroendocrines. Le diagnostic de certitude de ces lésions peut être difficile, même après la réalisation d’une échoendoscopique et/ou de biopsies. La résection chirurgicale des tumeurs de plus de 2 cm est justifiée car elle permet une analyse histologique et un traitement carcinologique. Concernant les TSM gastriques de petite taille (<2 cm), la résection par voie endoscopique est une alternative mini-invasive innovante au traitement chirurgical classique. Les techniques dérivées de la dissection sous-muqueuse telles que l’excavation endoscopique, le submucosal tunneling endoscopic resection et l’endoscopic full thickness resection, sont les techniques les plus évaluées. Les taux de résection carcinologique sont supérieurs à 90 % avec des taux de récidive faibles de 2 %. La survenue de complications sévères, comme les hémorragies, les pneumothorax et les perforations, est faible. Ces premiers résultats sont prometteurs, mais doivent être confirmés par des études avec un plus grand nombre de patients et avec un suivi à long terme pour s’assurer de l’absence de récidive.

Mots clés

Tumeur sous-muqueuse Traitement endoscopique Excavation endoscopique Résection endoscopique transpariétale Submucosal tunneling endoscopic resection 

Abbreviations

EEH

échoendoscopie haute

DSM

endoscopic submucosal dissection

EFTR

endoscopic full thickness resection

GIST

gastrointestinal stromal tumor

POEM

per oral endoscopic myotomy

STER

submucosal tunneling endoscopic resection

TSM

tumeur sous-muqueuse

Endoscopic resection of small gastric subepithelial tumors

Abstract

Subepithelial tumors (SETs) in the stomach are usually found incidentally during endoscopic examinations. Most gastric SETs are asymptomic and are formerly considered to have a benign nature, such as lipomas, shwannomas, leiymyomas. However, several gastric SETs have malignant potential, especially when they originate from the muscularis propria layer such as gastrointestinal stromal tumors or neuroendocrine tumors. SETs diagnostic is challenging, even after endoscopic ultrasound evaluation and biopsies. Thus, gastric SETs resection is justified because it provides histological analysis and curative treatment. For small gastric SETs (<2 cm), endoscopic resection is promising and associated with lower morbi-mortality comparatively to surgery. Resection techniques are close from endoscopic submucosal dissection, such as submucosal tunneling endoscopic resection or endoscopic full thickness resection. Some studies reported that complete resection rate was superior to 90% with low recurrence rates ranging from 0 to 2%. Severe adverse event occurrence (massive bleeding, perforation and pneumothorax) is rare. However, these promising results have to be confirmed in larger studies and with long term follow-up.

Keywords

Gastric subepithelial tumors Endoscopic treatment Submucosal tunneling endoscopic resection Endoscopic muscularis excavation Endoscopic full thickness resection 

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Copyright information

© Lavoisier 2016

Authors and Affiliations

  • G. Perrod
    • 1
  • G. Rahmi
    • 1
  • E. Samaha
    • 1
  • A. Vienne
    • 1
  • H. Benosman
    • 1
  • C. Savale
    • 1
  • S. Khater
    • 1
  • J.-B. Danset
    • 1
  • A.-L. Pointet
    • 2
  • L. Abbes
    • 1
  • G. Malamut
    • 1
  • B. Landi
    • 2
  • C. Cellier
    • 1
  1. 1.Service d’hépatogastroentérologie et d’endoscopie digestivehôpital européen Georges PompidouParisFrance
  2. 2.Service d’oncologie digestivehôpital européen Georges PompidouParisFrance

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