Clinical outcomes of per-oral endoscopic tumor resection for submucosal tumors in the esophagus and gastric cardia.

Abstract

The clinical success of per-oral endoscopic myotomy (POEM) has led to the development of a new field of 'submucosal endoscopy'. This study aimed to evaluate the safety, efficacy, and limitations of per-oral endoscopic tumor resection (POET) in the management of submucosal tumors (SMTs) in the esophagus and the gastric cardia. POET was performed in 47 patients from January 2011 to December 2017. The indication for POET was SMTs≤30mm in minor axis diameter. Patient and tumor characteristics (age, gender, tumor location, size, and histology), operative and clinical results of POET (procedure time and completion rate, en bloc resection rate, length of hospitalization, adverse events and tumor recurrence) were analyzed retrospectively. POET was successfully completed in 43 patients (91.5%) without any major adverse events (Clavien-Dindo IIIb-IV). Four patients required conversion to an open surgical procedure due to suboptimal visualization during POET. Four patients underwent piecemeal resection of their SMTs including GISTs. Median follow-up was 44months (10-96months), during that time, there were no incidences of tumor recurrence. Tumors that had a minor axis diameter>30mm or a tumor mass index (TMI) [major axis diameter (mm)×minor axis diameter (mm)] >1000 had a high likelihood of being converted to surgical resection. POET is a safe and effective treatment for SMTs. However, in patients where the minor axis diameter is>30mm or the TMI>1000, surgical excision should be considered. Furthermore, application of POET for SMTs with malignant potential should be carefully considered to ensure optimal oncologic outcomes.