Advertisement

Submucosal Tunneling Endoscopic Resection for Gastric Submucosal Tumors: a Comparison Between Cardia and Non-cardia Location

  • Yuyong Tan
  • Bingyi Zhou
  • Shilan Zhang
  • Feihong Deng
  • Rong Li
  • Shan Gao
  • Jirong Huo
  • Deliang LiuEmail author
Original Article
  • 43 Downloads

Abstract

Background and Purpose

Submucosal tunneling endoscopic resection (STER) was initially used to remove submucosal tumors (SMTs) located at the esophagus and cardia; only few researchers have reported the feasibility of STER for gastric SMTs beyond cardia due to the technical difficulty, and little is known about the comparison of STER for cardia and non-cardia gastric SMTs. The purpose was to compare the feasibility and efficacy of STER for cardia and non-cardia gastric SMTs, as well as to explore the risk factors for failure of en bloc resection.

Methods

We retrospectively collected the clinical data about patients with gastric SMTs who received STER at our hospital from June 2012 to June 2018. Demographics, tumor size, procedure-related parameters, complications, hospital stay, and follow-up data were compared between cardia and non-cardia SMTs. And multivariate analyses were conducted to look for the risk factors for failure of en bloc resection.

Results

A total of 46 SMTs were removed, and 25 of them were located at cardia, while the other 21 at non-cardia position. There was no significant difference between the two groups in terms of gender, age, tumor size, en bloc resection rate, operation time, complications, and hospital stay (p > 0.05). No recurrence was noticed in all the cases. Multivariate analyses revealed that irregular shape was an independent risk factor for failure of en bloc resection.

Conclusion

STER is feasible for both cardia and non-cardia gastric SMTs, and the efficacy between cardia and non-cardia location is comparable. Irregular shape was an independent risk factor for failure of en bloc resection.

Keywords

Submucosal tunneling endoscopic resection Gastric submucosal tumors Endoscopic gastrointestinal surgery Efficacy En bloc resection 

Notes

Grant Support

This study was funded by Development and Reform Commission of Hunan Province (XFGTZ2014713).

Authors’ Contribution

Conception of the work: YT and DL; acquisition, analysis, and interpretation of the data: YT, BZ, SZ, FD, RL, and SG; drafting the manuscript: YT; critically revise for important intellectual content: JH and DL; final approve of the manuscript: all authors.

Compliance with Ethical Standards

This is a single-center, retrospective study and was approved by the ethics committee of the Second Xiangya Hospital of Central South University, and all the patients signed informed consent.

References

  1. 1.
    Nishida T, Kawai N, Yamaguchi S, Nishida Y. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 2013;25:479–489.CrossRefGoogle Scholar
  2. 2.
    Kim GH. Endoscopic resection of subepithelial tumors. Clin Endosc 2012;45: 240–244.CrossRefGoogle Scholar
  3. 3.
    Kim SY, Kim KO. Management of gastric subepithelial tumors: The role of endoscopy. World J Gastrointest Endosc 2016;8:418–424.CrossRefGoogle Scholar
  4. 4.
    Tan Y, Tan L, Lu J, Huo J, Liu D. Endoscopic resection of gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol 2017;2:115.CrossRefGoogle Scholar
  5. 5.
    Tan Y, Tang X, Guo T, Peng D, Tang Y, Duan T, Wang X, Lv L, Huo J, Liu D. Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer. Surg Endosc 2017;31:3376–3382.CrossRefGoogle Scholar
  6. 6.
    Duan TY, Tan YY, Wang XH, Lv L, Liu DL. A comparison of submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric fundus submucosal tumors. Rev Esp Enferm Dig 2018;110:160–165.CrossRefGoogle Scholar
  7. 7.
    Zhang Q, Wang F, Wei G, Cai JQ, Zhi FC, Bai Y. Endoscopic resection of gastric submucosal tumors: A comparison of endoscopic nontunneling with tunneling resection and a systematic review. Saudi J Gastroenterol 2017;23: 52–59.CrossRefGoogle Scholar
  8. 8.
    Du C, Chai N, Linghu E, Gao Y, Li Z, Li L, Zhai Y, Lu Z, Meng J, Tang P. Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation. Surg Endosc 2018; doi:  https://doi.org/10.1007/s00464-018-6206-0.
  9. 9.
    Wang H, Tan Y, Zhou Y, Wang Y, Li C, Zhou J, Duan T, Zhang J, Liu D. Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol 2015;27:776–780.CrossRefGoogle Scholar
  10. 10.
    Inoue H, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Eleftheriadis N, Maselli R, Kudo S. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012;44:225–230.CrossRefGoogle Scholar
  11. 11.
    Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 2012;75:195–199.CrossRefGoogle Scholar
  12. 12.
    Li QL, Chen WF, Zhang C, Hu JW, Zhou PH, Zhang YQ, Zhong YS, Yao LQ, Xu MD. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc 2015;29:3640–3646.CrossRefGoogle Scholar
  13. 13.
    Lu J, Jiao T, Li Y, Liu Y, Wang Y, Wang Y, Zheng M, Lu X. Heading toward the right direction--solution package for endoscopic submucosal tunneling resection in the stomach. PLoS One 2015;10:e0119870.CrossRefGoogle Scholar
  14. 14.
    Lu J, Zheng M, Jiao T, Wang Y, Lu X. Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy 2014;46:888–892.CrossRefGoogle Scholar
  15. 15.
    Zhou H, Tan Y, Wang C, Yang J, Zhou Y, Liu D. Removal of an extraluminal gastric gastrointestinal stromal tumor: the role of submucosal tunneling endoscopic resection. Endoscopy 2017;49:E11-E13.CrossRefGoogle Scholar
  16. 16.
    Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw 2010; Suppl 2:S1–41; quiz S42–44Google Scholar
  17. 17.
    Zhang Q, Cai JQ, Xiang L, Wang Z, de Liu S, Bai Y. Modified submucosal tunneling endoscopic resection for submucosal tumors in the esophagus and gastric fundus near the cardia. Endoscopy 2017;49:784–791.CrossRefGoogle Scholar
  18. 18.
    Mao XL, Ye LP, Zheng HH, Zhou XB, Zhu LH, Zhang Y. Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer. Dis Esophagus 2017;30:1–7.CrossRefGoogle Scholar
  19. 19.
    Tan Y, Huo J, Liu D. Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer. Oncol Lett 2017;14:5085–5090.CrossRefGoogle Scholar
  20. 20.
    Du C, Linghu E. Submucosal Tunneling Endoscopic Resection for the Treatment of Gastrointestinal Submucosal Tumors Originating from the Muscularis Propria Layer. J Gastrointest Surg 2017;21(12):2100–2109.CrossRefGoogle Scholar
  21. 21.
    Zhang Q, Li Y, Meng Y, Bai Y, Cai JQ, Han ZL, Wang Z, Zhi FC, Liu SD. Should the Integrity of Mucosa Be Considered in Endoscopic Resection of Gastric Submucosal Tumors? Gastroenterology 2016;150:822–824 e829.CrossRefGoogle Scholar
  22. 22.
    Li Y, Zhang Q, Zhu C, Luo Y, Han Z, Qing H, Cai J, Li L, Huang Y, Liu S. Endoscopic mucosa-sparing lateral dissection for treatment of gastric submucosal tumors: a prospective cohort study. Endoscopy 2018;50:886–890.CrossRefGoogle Scholar
  23. 23.
    Zhang Q, Li Y, Lian ZY, Wang Z, Wang LH, Bai Y, Liu SD. A modified endoscopic method for resection of gastric submucosal tumor. Surg Endosc 2018;32:536–543.CrossRefGoogle Scholar
  24. 24.
    Chen T, Zhou PH, Chu Y, Zhang YQ, Chen WF, Ji Y, Yao LQ, Xu MD. Long-term Outcomes of Submucosal Tunneling Endoscopic Resection for Upper Gastrointestinal Submucosal Tumors. Ann Surg 2017;265:363–369.CrossRefGoogle Scholar
  25. 25.
    Li Z, Gao Y, Chai N, Xiong Y, Ma L, Zhang W, Du C, Linghu E. Effect of submucosal tunneling endoscopic resection for submucosal tumors at esophagogastric junction and risk factors for failure of en bloc resection. Surg Endosc 2018;32:1326–1335.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology, The Second Xiangya HospitalCentral South UniversityChangshaChina

Personalised recommendations