Combination of endoscopic submucosal dissection and endoscopic band ligation in treatment of upper gastrointestinal submucosal tumors

Abstract

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） combined with endoscopic band ligation for removal of the upper gastrointestinal submucosal tumors （SMTs） originated from the museularis propria layer after examination with miniprobe endoscopic uhrasonography （EUS）. Methods Patients with suspected SMT under endoscopy received miniprobe EUS, and the SMT originated from muscularis propria layer were removed endoscopically. The lesions were ligated with a band, after which the mucosa in middle of the lesion was pre-cut with a needle knife, and then the submucosal tissue was dissected to expose and resect the lesion completely. Results A total of 13 SMTs originated from muscularis propria layer were removed, in which 7 lesions were diagnosed pathologically as gastrointestinal stromal tumor, 5 as leiomyoma, and 1 as gastric angioma. The diameter of the lesions ranged from 0. 8 to 1.5 cm with a mean size of 1.2 cm. Postoperative perforation occurred in 1 case, which received successful closure with endoclip without surgical intervention. Conclusion ESD combined with endoscopic band ligation, an effective and safe endoscopic surgical procedure to resect the upper gastrointestinal SMT（ size ≤ 1.5 cm） originated from the muscularis propria layer, is able to provide pathologic data and achieve the efficacy equivalent to surgery. Key words: Endoscopic ultrasonography; Endoscopic band ligation; Submucosal tumor; Muscularis propria layer