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Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos)

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Abstract

Background

The esophagogastric junction (EGJ) is a difficult location for endoscopic resection due to its narrow lumen and sharp angle. Potential increased risks of perforation and mediastinal infection exist, especially for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. We previously demonstrated the safety and efficacy of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal SMTs, but the feasibility of STER for the removal of SMTs at the EGJ requires systematic investigation. The aim of the investigation was to evaluate the clinical impact of STER on the removal of SMTs at the EGJ.

Methods

A prospective study was carried out which included a consecutive cohort of 57 patients who underwent STER for 57 SMTs of the EGJ originating from the MP layer between July 2010 and August 2012 in a single academic medical center. Adverse events, en bloc resection rate, and local recurrence were evaluated.

Results

The average maximum diameter of the lesions was 21.5 mm (range 6–35 mm). The en bloc resection rate was 100 % (57/57). No delayed hemorrhage or severe adverse events occurred in any of the 57 patients following STER. No local recurrence and distant metastasis occurred during 24 months’ follow-up. Less subcutaneous emphysema and pneumomediastinum absorption time (p = 0.005) occurred with CO2 versus air insufflations.

Conclusions

Our study showed that STER was safe and effective, provided accurate histopathologic evaluation, and was curative for SMTs of the deep MP layers at the EGJ. CO2 gas insufflation is recommended.

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Acknowledgment

This study was supported as a project of the National Natural Science Foundation of China (grant no. 1071046) and a major project of the Shanghai Municipal Science and Technology Committee (09DZ1950102, 11411950500, and 11DZ2280400), and Natural Science Foundation of Xinjiang Uygur Autonomous Region (2011211B30).

Disclosures

Xiao-Yun Wang, Li-Qing Yao, Ping-Hong Zhou, Douglas Pleskow, Quan-Lin Li, Yi-Qun Zhang, Wei-Feng Chen and Yun-Shi Zhong have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People’s Republic of China

    Xiao-Yun Wang, Mei-Dong Xu, Li-Qing Yao, Ping-Hong Zhou, Quan-Lin Li, Yi-Qun Zhang, Wei-Feng Chen & Yun-Shi Zhong

  2. Department of Gastroenterology, Wuxi Second People’s Hospital, Wuxi, Jiangsu, People’s Republic of China

    Xiao-Yun Wang

  3. Division of Gastroenterology, Beth Israel Deaconess Hospital, Boston, MA, USA

    Douglas Pleskow

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  1. Xiao-Yun Wang
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  2. Mei-Dong Xu
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Corresponding author

Correspondence to Mei-Dong Xu.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1. Locating the tumor site to guide the direction of the submucosal tunnel (WMV 5130 kb)

Video 2. Creation of the submucosal tunnel to expose the tumor using the hybrid knife (WMV 9873 kb)

Video 3. Resection of the submucosal tumor under direct endoscopic view using the hook knife and insulated-tip knife (WMV 12568 kb)

Video 4. Closure of the mucosal incision site with the hemostatic clips (WMV 2318 kb)

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Wang, XY., Xu, MD., Yao, LQ. et al. Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos). Surg Endosc 28, 1971–1977 (2014). https://doi.org/10.1007/s00464-014-3420-2

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  • DOI: https://doi.org/10.1007/s00464-014-3420-2

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