Comparison of Endoscopic and Surgical Removal for Gastric Subepithelial Tumors Arising from Muscularis Propria Layer

Abstract

Background: Gastric subepithelial tumors (SETs) are usually found incidentally during endoscopic or radiologic evaluation. Establishing accurate diagnosis of SETs arising from the muscularis propria (MP) layer becomes important because a subset of these lesions may have malignant potential. Gastric SETs from MP was removed with operation but endoscopic resection method has been developed for the pathologic diagnosis and eradication of SETs. The aim of present study is to evaluate the feasibility, effectiveness, safety and outcome of endoscopic resection and to compare with those of surgical operation for treatment of gastric SETs arising from MP layer. Patients & Methods: Endoscopic and surgical resection was attempted between Jan 2001 and Sep 2007 in 61 patients (29 men, 32 women, mean age 47 years) and 63 patients (26 men, 37 women, mean age 53 years) with gastric SET less than 5 cm from the MP layer, respectively. The following parameters were retrospectively recorded and analyzed; success rate, SET size, operation or procedure time, hospital day from procedure to discharge, complications, pathologic findings, risk factor for complication. Results: 52.4% of patients of endoscopic treatment group and 69.8% of surgery group had no symptom. 25.5% of lesions of surgery group and 31.1% of endoscopic group were located in proximal stomach (cardia and fundus). 16 cases of surgery group had open surgery and remaining 47 cases had laparoscopic surgery. Mean tumor size of surgery group was significantly larger than endoscopic group (32.49 vs 18.48 mm, p = 0.00). Procedure time was significantly longer in surgery group than in endoscopic group (116.0 vs 62.25 min, p = 0.00). Hospital day was significantly longer in surgery group than in endoscopic group (7.84 vs 3.2 days, p = 0.000). All of 63 lesions could be removed surgically. 80.3% of lesions (49/61) could be removed with endoscopic treatment. The causes of endoscopic resection failure were tumor adhesion (5 cases), perforation (3), broad base of tumor (2), and bleeding (2). 12 patients of endoscopic removal failure had laparoscopic operation. Final diagnosis of surgery group was GIST (44cases), leiomyoma (6), schwannoma (6), inflammatory fibrinoid polyp (4), ectopic pancreas (2), and gastritis cystica profunda (1). 3 cases of GIST were aggressive type. Final diagnosis of endoscopic group was GIST (27), leiomyoma (29), ectopic pancreas (2), and schwannoma (3). 2 cases of GIST were aggressive types. Conclusion: Endoscopic resection appears to be as effective method as surgical treatment for definite diagnosis and treatment of gastric SETs arising from the MP, if appropriate indication is used in experienced hands.