Submucosal tunneling endoscopic resection of large submucosal tumors originating from the muscularis propria layer in the esophagus and gastric cardia

Abstract Aims The aim of this study was to evaluate the short-term complications of submucosal tunneling endoscopic resection (STER) for large submucosal tumors (SMTs) originating from the muscularis propria (MP) layer in the esophagus and gastric cardia. Methods We performed 286 cases of STER from September 2012 to December 2017. The clinical data of patients with SMTs originating from the MP layer of 3.0–7.0 cm, who underwent STER procedure at the endoscopy center of Tianjin Medical University General Hospital, were collected retrospectively. Epidemiological data, tumor location, tumor size, procedure-related parameters, complications, and follow-up were included. Results A total of 27 (9.4 % [27/286]) patients were large-size SMTs, with a mean age of 51.9 ± 9.4 years. The male/female ratio was 19:8. Of the 27 SMTs, 23 were located in the esophagus and 4 in the gastric cardia. The mean tumor size was 4.0 ± 1.1 cm. The en bloc resection rate was 85.2 % (23/27), and the complete resection rate was 100 % (27/27). Intra-operative perforation occurred in 2 patients (7.4 %) and post-operative perforation occurred in 2 patients (7.4 %). No other complications were observed. The average cost of the procedure was $3357.99 ± $1171.60 per inpatient stay (including both the procedure and an additional inpatient stay). The mean follow-up time was 15 ± 10.1 months. No recurrence and metastasis occurred during the follow-up period. Conclusions There is low risk of STER for the large-sized SMTs in the esophagus and gastric cardia, and the most common complication occurred during or after the procedure is perforation.

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Open submucosal tunneling endoscopic resection for special submucosal tumors originating from the muscularis propria

10.21203/rs.3.rs-21242/v1 ◽

2020 ◽

Author(s):

Silin Huang ◽

Sufang Tu ◽

Jingwen Fu ◽

Xiaowei Tang ◽

Genhua Yang ◽

...

Keyword(s):

Endoscopic Resection ◽

Muscularis Propria ◽

Operation Time ◽

Primary Treatment ◽

En Bloc ◽

Submucosal Tunneling Endoscopic Resection ◽

Submucosal Tumors ◽

Endoscopic Techniques ◽

The Mean

Abstract Background and Purpose Esophageal submucosal tumors (SMTs) are primarily benign but can have the potential for malignancy. Surgery is the primary treatment; however, the development of endoscopic techniques has promoted the use of endoscopic resection for esophageal SMTs. Submucosal tunneling endoscopic resection (STER) is the current optimal treatment for esophageal SMTs; however, it is challenging to perform in cases of tumors located in the upper esophagus and cardia as well as those with a diameter > 3.5 cm. Based on STER, we proposed and used open STER (O-STER) for special esophageal SMTs. The study aimed to evaluate the safety and efficacy of O-STER for special esophageal SMTs, including those located in the upper esophagus and cardia and those with a diameter > 3.5 cm. Methods The study enrolled 21 patients whose baseline characteristics, clinical data, and follow-up results were retrospectively analyzed. Results A total of 21 lesions were resected. The mean patient age was 44.2 ± 14.4 years. The mean tumor size was 38.2 ± 12.2 mm; 16 (76.2%) tumors had a diameter ≥ 3.5 cm. Tumors were in the cardia in 14 (66.7%) cases and in the upper esophagus in 2 (9.5%) cases. The mean operation time was 56.7 ± 19.3 minutes. The en bloc and complete resection rates were both 100%. There was 1 (4.8%) case of subcutaneous emphysema; no other serious complications were noted. Pathological examinations suggested that most tumors were leiomyomas and had negative margins. During the mean follow-up period of 26.7 months, no cases of residue, recurrence, or metastasis were observed. Conclusions O-STER is a safe and effective treatment for special esophageal SMTs that can reduce operative difficulty and complication rate.

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Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study

Gastroenterology Research and Practice ◽

10.1155/2018/2149564 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Sufang Tu ◽

Silin Huang ◽

Guohua Li ◽

Xiaowei Tang ◽

Haitao Qing ◽

...

Keyword(s):

Endoscopic Resection ◽

Muscularis Propria ◽

Benign Tumors ◽

Resection Rate ◽

Submucosal Tumors ◽

Muscularis Propria Layer ◽

Submucosal Tunnel ◽

The Mean ◽

Submucosal Tunnel Endoscopic Resection

Background. Submucosal tumors (SMTs) are primarily benign tumors, but some may have a malignant potential. Endoscopic submucosal dissection that has been used for removing esophageal SMTs could cause perforation. Submucosal tunnel endoscopic resection (STER) is an improved and an effective technique for treating esophageal SMTs.Aims. This study was conducted to evaluate the efficacy and safety of STER for treating esophageal SMTs.Methods. A retrospective study design was adopted to analyze the baseline characteristics, clinical outcomes, and follow-up data of patients with esophageal SMTs, which originated from the muscularis propria layer and were treated with STER from September 2011 to May 2018.Results. A total of 119 lesions were included from 115 patients who were successfully treated with STER. The mean age of the patients was 49.7 ± 10.7 years. The lesions were primarily located in the middle and lower esophagus. The mean size of the lesions was 19.4 ± 10.0 mm. The mean operation duration was 46.7 ± 25.6 min, and the mean duration of hospitalization was 5.9 ± 2.8 days. The total en bloc resection rate and the complete resection rate were 97.5% and 100%, respectively. Regarding complications, there were 9 (7.8%) cases of perforation, 2 (1.7%) cases of pneumothorax, and 9 (7.8%) cases of subcutaneous emphysema. Histopathological results revealed 113 (95.0%) cases of leiomyoma, 5 (4.2%) cases of gastrointestinal stromal tumors, and 1 (0.8%) case of a granular cell tumor. During the mean 15-month follow-up, there were no cases of recurrence and distant metastasis.Conclusions. STER is a safe and feasible technique for treating esophageal SMTs originating from the muscularis propria layer.

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Comparison of different endoscopic resection techniques for submucosal tumors originating from muscularis propria at the esophagogastric junction

BMC Gastroenterology ◽

10.1186/s12876-019-1099-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Hong-wei Xu ◽

Qi Zhao ◽

Shu-xia Yu ◽

Ying Jiang ◽

Jing-hua Hao ◽

...

Keyword(s):

Endoscopic Resection ◽

Tumor Recurrence ◽

Esophagogastric Junction ◽

Muscularis Propria ◽

Operation Time ◽

Complete Resection ◽

Resection Rate ◽

Submucosal Tunneling Endoscopic Resection ◽

Submucosal Tumors ◽

Complete Resection Rate

Abstract Background To compare the outcomes of submucosal tunneling endoscopic resection (STER) and submucosal excavation (ESE) for the treatment of submucosal tumors (SMTs) arising from the muscularis propria (MP) at the esophagogastric junction (EGJ). Methods A retrospective analysis of patients with SMTs at EGJ who underwent STER and ESE from October 2011 to October 2017 was performed. The outcomes evaluated were operation time, complete resection rate, adverse events, and tumor recurrence. Results Ninety patients were included in this study. Complete resection rates in the STER group were higher than those of the ESE group (100 vs. 92%, p < 0.05). For tumors ≤15 mm, both techniques achieved 100% complete resection rate; but for tumors > 15 mm, complete resection rate was higher in the STER group than the ESE group (100% vs. 77.8%, p < 0.05). Subgroup analyses revealed that the operation time of STER for in cardiac-gastric group was longer than that for ESE (145.14 ± 42.43 min vs. 70.32 ± 39.84 min, p < 0.05). The air leakage symptoms were more frequent in STER group (90.9% vs. 50.0%, p < 0.05). No tumor recurrence occurred in both the STER and ESE groups. Conclusions For SMTs ≤15 mm, both STER and ESE have similar satisfactory therapeutic outcomes. However, in the cardiac-gastric subgroup, STER had a longer operative time compared to the ESE procedure. For SMTs > 15 mm, STER is the preferred choice due to its higher complete resection rate.

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