Abstract
BackgroundTo 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).MethodsA 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.ResultsNinety 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.ConclusionsFor 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.
Highlights
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)
It has been reported that gastrointestinal SMTs, especially those originating from the muscularis mucosa ventriculi and submucosa, can be successfully removed by endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), and endoscopic full-thickness resection (EFR) [10]
The exclusion criteria were as follows: (1) lesions originating from the mucosal/submucosal layer; (2) patients unfit for general anesthesia; (3) predominant extraluminal growth was shown by endoscopic ultrasonography (EUS) or computed tomography (CT)
Summary
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). SMTs are usually covered with normal gastrointestinal mucosa, and most patients have no specific clinical manifestations [2]. Surgical wedge resection was the preferred option for SMTs [5]. With advancements in technologies and techniques, therapeutic endoscopic procedures have evolved as alternative approaches for the excision of SMTs [6,7,8,9]. It has been reported that gastrointestinal SMTs, especially those originating from the muscularis mucosa ventriculi and submucosa, can be successfully removed by endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), and endoscopic full-thickness resection (EFR) [10].
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