Effect of Submucosal Tunneling Endoscopic Resection for Submucosal Tumors Originating From the Muscularis Propria Layer in the Esophagogastric Junction and Risk Factors for Failure of En Bloc Resection: 2017 Presidential Poster Award

2017 ◽  
Vol 112 ◽  
pp. S679-S680
Author(s):  
Zhenjuan Li ◽  
Ying Gao ◽  
Ningli Chai ◽  
Ying Xiong ◽  
Lianjun Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Resection ◽  
Esophagogastric Junction ◽  
Muscularis Propria ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Tumors ◽  
Poster Award

scholarly journals Feasibility and Safety of Mark-Guided Submucosal Tunneling Endoscopic Resection for Treatment of Esophageal Submucosal Tumors Originating from the Muscularis Propria: A Single-Center Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ben-hua Wu ◽  
Rui-yue Shi ◽  
Hai-yang Zhang ◽  
Ting-ting Liu ◽  
Yan-hui Tian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Muscularis Propria ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Tumors ◽  
Procedure Duration

Background. Submucosal tunneling endoscopic resection (STER) has effectively removed esophageal submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. However, clinical failure and adverse events of STER remain concerned. In this study, we described a mark-guided STER (markings before creating entry point) and evaluated its feasibility and safety for esophageal SMTs originating from MP. Methods. Patients receiving the mark-guided STER from October 2017 to July 2020 were included and followed up (ranged from 3 to 30 months). The primary outcomes included complete resection, en bloc resection, and R0 resection rates. The secondary outcomes included procedure duration, main complication, and residual lesions. Results. A total of 242 patients with 242 SMTs (median diameter of 22 mm, ranging from 7 mm to 40 mm) received the mark-guided STER. The median procedure duration was 55 min (ranging from 35 min to 115 min). The complete resection, en bloc resection, and R0 resection rates were 100%, 98.3%, and 97.5%, respectively. The adverse event rate was 4.5%. However, there was no severe complication. No residual SMTs were detected during the follow-up period. Logistic regression demonstrated that the SMT size and procedure duration were independent factors associated with en bloc resection ( P = 0.02 and P = 0.04 , respectively). Moreover, logistic regression demonstrated that the SMT size was an independent risk factor for main complications ( P = 0.02 ). Conclusion. Mark-guided STER was feasible and safe to remove esophageal SMTs ≦40 mm. However, it is necessary to further verify the feasibility and safety for the esophageal SMTs >40 mm.

Efficacy and complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors and exploration for influencing factors

2018 ◽  
Vol 56 (04) ◽  
pp. 365-373 ◽  
Author(s):  
Shunzhe Song ◽  
Xu Wang ◽  
Shen Zhang ◽  
Yanxia Li ◽  
Xiaonan Zhang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
Cochrane Library ◽  
En Bloc ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Tumors ◽  
Upper Gi ◽  
Upper Gastrointestinal

Abstract Background Submucosal tunneling endoscopic resection (STER) has emerged as a feasible technique for resecting upper gastrointestinal (GI) tract submucosal tumors (SMTs) through natural orifice transluminal endoscopic surgery. STER reduces the risk of postoperative perforation and abdominal infections and promotes rapid wound healing. The aim of this meta-analysis was to evaluate the safety and efficacy of STER for small (≤ 3.5 cm) upper GI SMTs and explore the potential factors influencing STER’s efficacy and complication rate. Methods Comprehensive literature searches were performed to find studies on STER for removal of SMTs. Several English-language databases were searched, including MEDLINE (through PubMed), EMBASE, and the Cochrane Library for the period January 2010 to June 2016. The medical terms “submucosal tunneling endoscopic resection or STER”, “upper gastrointestinal”, and “submucosal tumors” were used in the search. The primary outcome measures were the pooled estimates of the complete resection and en bloc resection rates. The secondary outcome measure was the pooled estimate of complications. Result Twelve studies including 397 patients and 430 lesions were identified. The pooled estimate of the complete resection rate was 98.1 % (95 % confidence interval [CI]: 95.9 – 99.2 %). The pooled estimate of en bloc resection was 94.9 % (95 % CI: 91.1 – 97.1 %). The pooled estimate of gas-related complications such as pneumoperitoneum and subcutaneous emphysema was 21.5 % (95 % CI: 13.2 – 33.1 %). The pooled estimate of inflammation-related complications including pleural and abdominal effusion was 8.4 % (95 % CI: 5.6 – 12.3 %). Gas-related complications occurred more frequently in the esophagogastric junction than in the stomach. In addition, the pooled estimate of delayed bleeding was 2.2 % (95 % CI: 1.0 – 4.7 %). Conclusion STER appeared to be an extremely effective technique for removing upper GI SMTs originating from the muscularis propria layer. In addition, the very low rate of complications also shows the safety of this technique. Tumor size, infiltration depth, and location may influence the complication rates.

scholarly journals Endoscopic submucosal dissection and tunneling procedures using a novel all-in-one bipolar device

2020 ◽  
Vol 08 (10) ◽  
pp. E1302-E1307
Author(s):  
Zaheer Nabi ◽  
Radhika Chavan ◽  
Mohan Ramchandani ◽  
Zacharias Tsiamoulos ◽  
Jahanqeer Basha ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Rectal Polyp ◽  
En Bloc ◽  
Epithelial Tumor ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Dissection ◽  
Bipolar Device

Abstract Background and study aims Recent innovations in devices and techniques have revolutionized the field of endoscopic resection procedures. In this study, we evaluated the safety and feasibility of endoscopic submucosal dissection and tunneling procedures with a novel, multipurpose bipolar device. Patients and methods Data from consecutive patients who underwent per-oral endoscopic myotomy (POEM), submucosal tunneling endoscopic resection (STER), and endoscopic submucosal dissection (ESD) using a novel bipolar device (December 2019 to February 2020) were analyzed retrospectively. Procedure duration, technical success, and adverse events (AEs) were recorded. Results A total of 10 procedures were performed using the novel bipolar device during the study period. The procedures included POEM (n = 7), STER for esophageal sub-epithelial tumor (n = 1), ESD for rectal polyp (n = 1), and gastric neuroendocrine tumor (n = 1). POEM was successfully completed in all patients. In patients who underwent STER and ESD, en-bloc resection was achieved in all. Mean procedure time for submucosal tunneling procedures (POEM and STER) was 59.12 ± 31.12 minutes. The procedures were completed without the requirement for exchange of accessories in eight cases (80 %). There were no major AEs. Mild and moderate AEs occurred during POEM and included capno-peritoneum (n = 1), retroperitoneal CO2 (n = 1), and empyema (n = 1). Conclusion ESD and tunneling procedures can be safely performed without the need for exchange of accessories using a novel bipolar device. Randomized comparison with conventional knives isrequired to confirm the utility of this device.

Endoscopic mucosa-sparing lateral dissection for treatment of gastric submucosal tumors: a prospective cohort study

Endoscopy ◽  
2018 ◽  
Vol 50 (09) ◽  
pp. 886-890 ◽  
Author(s):  
Yue Li ◽  
Qiang Zhang ◽  
Chaojun Zhu ◽  
Yuchen Luo ◽  
Zelong Han ◽  
...  
Keyword(s):  
Large Scale ◽  
Muscularis Propria ◽  
En Bloc Resection ◽  
Clinicopathological Characteristics ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Tumors ◽  
Gastric Submucosal Tumors ◽  
Estimated Blood Loss ◽  
The Mean

Abstract Background In our previous work, we developed a modified method for the removal of gastric submucosal tumors (SMTs), called endoscopic mucosa-sparing lateral dissection (EMSLD). This prospective study aimed to evaluate the efficacy and postoperative outcomes of EMSLD. Methods We prospectively enrolled 25 consecutive patients with gastric SMTs, who received EMSLD treatment. Clinicopathological characteristics and operation-related outcomes were analyzed. Results The mean age of patients was 49.3 ± 9.7 years, and the mean tumor size was 14.6 ± 6.1 mm. En bloc resection was achieved in all cases. The mean procedure time was 47.3 ± 25.9 minutes, and the estimated blood loss was 4.8 ± 3.5 mL. Endoscopic full-thickness resection was performed in six patients (24 %) because the tumors originated from the deep muscularis propria layer. All perforations and resection defects were successfully closed by the retained mucosa and endoclips. No serious complications related to EMSLD were encountered during or after the procedure. Conclusions EMSLD was reliable and effective for the removal of gastric SMTs. However, large-scale randomized controlled trials are needed.

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

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.

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

2019 ◽  
Vol 19 (1) ◽  
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.

scholarly journals Factors predicting technical difficulties during endoscopic submucosal excavation for gastric submucosal tumor

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110298
Author(s):  
Jia Liu ◽  
Yuyong Tan ◽  
Deliang Liu ◽  
Chenjie Li ◽  
Meixian Le ◽  
...  
Keyword(s):  
Risk Factors ◽  
Submucosal Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Tumors ◽  
Gastric Submucosal Tumors ◽  
Inexperienced Surgeon ◽  
Endoscopic Submucosal Excavation

Objective Endoscopic submucosal excavation (ESE) has been established as an effective method for removal of gastric submucosal tumors (SMTs). The aim of the present study was to explore risk factors for technical difficulties in ESE. Methods In this retrospective study, we collected clinical data from patients who underwent ESE for gastric SMTs. Difficult ESE was defined as a procedure time ≥90 minutes, piecemeal resection, and/or occurrence of major adverse events. Univariate and multivariate analyses were performed to explore the risk factors for a difficult ESE. Results ESE was successfully performed in 96.5% (195/202) of patients from April 2011 to December 2019. The average tumor size was 17.41 mm, and en bloc resection was achieved in 97.4% of patients (190/195). Five patients (2.56%, 5/195) had complications, including two with delayed bleeding, two with fever, and one with chest pain accompanying ST-T changes in an electrocardiogram. Twenty-four patients (11.88%, 24/202) had a difficult ESE. Logistic analysis showed that outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE. Conclusion ESE may be safe and effective to treat patients with gastric SMTs. Outgrowth behavior and an inexperienced surgeon were risk factors for a difficult ESE.

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