Abstract
Background
Endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) are nowadays both adopted by endoscopists to resect upper gastrointestinal submucosal tumors (SMTs) arising from muscularis propria. This study aimed to compare the efficacy and safety of these two techniques.
Methods
Seventy-seven patients were included in this retrospective study, among them, 35 received ESE and 42 received STER. Main outcome measurements included complete resection rate, perforation rate, adverse events, and tumor recurrence. Subgroup analysis based on tumor size was also performed.
Results
In general, ESE and STER had similar complete resection rate (94.7 vs. 97.7 %), perforation rate (10.5 vs. 13.3 %), and incidence of postoperative air leakage symptoms (13.2 vs. 2.2 %). No tumor recurrence occurred in any group. Subgroup analysis revealed that for tumors <10 mm, both techniques achieved satisfactory therapeutic effects (100 % complete resection, no adverse events); for tumors >10 mm, perforation rate increased in both ESE and STER (16 vs. 18.2 %), yet incidence of air leakage symptoms was significantly low in STER (3 %) compared to it in ESE (20 %).
Conclusions
For SMTs <10 mm, both ESE and STER have satisfactory therapeutic results, it is not necessary to pursue a difficult procedure when a simple method is available. For SMTs >10 mm, STER is a preferable choice in terms of preventing air leakage symptoms, especially, when perforation is likely to happen.
Similar content being viewed by others
References
Abe N, Takeuchi H, Ooki A, Nagao G, Masaki T, Mori T, Sugiyama M (2013) Recent developments in gastric endoscopic submucosal dissection: towards the era of endoscopic resection of layers deeper than the submucosa. Dig Endosc 25(Suppl 1):64–70
ESMO/European Sarcoma Network Working Group (2012) Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 23(suppl 7):vii49–vii55
Park YS, Park SW, Kim TI, Song SY, Choi EH, Chung JB, Kang JK (2004) Endoscopic enucleation of upper-GI submucosal tumors by using an insulated-tip electrosurgical knife. Gastrointest Endosc 59:409–415
Liu BR, Song JT, Qu B, Wen JF, Yin JB, Liu W (2012) Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria. Surg Endosc 26:3141–3148
Chun SY, Kim KO, Park DS, Lee IJ, Park JW, Moon SH, Baek IH, Kim JH, Park CK, Kwon MJ (2013) Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: a preliminary analysis of appropriate indications. Surg Endosc 27:3271–3279
Huang ZG, Zhang XS, Huang SL, Yuan XG (2012) Endoscopy dissection of small stromal tumors emerged from the muscularis propria in the upper gastrointestinal tract: preliminary study. World J gastrointest endosc 4:565–570
Chu YY, Lien JM, Tsai MH, Chiu CT, Chen TC, Yang KC, Ng SC (2012) Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer. BMC gastroenterol 12:124
Gong W, Xiong Y, Zhi F, Liu S, Wang A, Jiang B (2012) Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors. Endoscopy 44:231–235
Wang L, Ren W, Zhang Z, Yu J, Li Y, Song Y (2013) Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma. Surg Endosc 27:4259–4266
Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou X, Chen JY (2013) Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg endosc 28:524–530
Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75:195–199
Liu BR, Song JT, Kong LJ, Pei FH, Wang XH, Du YJ (2013) Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia. Surg Endosc 27:4354–4359
Joensuu H (2008) Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 39:1411–1419
Sepe PS, Brugge WR (2009) A guide for the diagnosis and management of gastrointestinal stromal cell tumors. Nat Rev Gastroenterol Hepatol 6:363–371
Dumonceau JM, Polkowski M, Larghi A, Vilmann P, Giovannini M, Frossard JL, Heresbach D, Pujol B, Fernandez-Esparrach G, Vazquez-Sequeiros E, Gines A (2011) Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 43:897–912
Grotz TE, Donohue JH (2011) Surveillance strategies for gastrointestinal stromal tumors. J Surg Oncol 104:921–927
Shi Q, Zhong YS, Yao LQ, Zhou PH, Xu MD, Wang P (2011) Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc 74:1194–1200
Disclosures
Drs. Jiaoyang Lu, Taotao Jiao, Minhua Zheng, and Xuefeng Lu have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Lu, J., Jiao, T., Zheng, M. et al. Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection. Surg Endosc 28, 3401–3407 (2014). https://doi.org/10.1007/s00464-014-3610-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3610-y