Endoscopic Esophageal Submucosal Tunnel Dissection for Cystic Lesions Originating from the Muscularis Propria of the Gastric Cardia.

Lu Liu,Jia Ma,Shu-Hua Jiao,Yan Zheng,Zhi-Feng Zhao,Feng Miao,Yin-Si Tang,Shen Zhang,Ying Sun,Nuo Li,Yang Weng,Shuang Cai,Yan Yang,Peng-Liang Liu,Feng Zhao,Shan-Shan Zhang,Hai-Mei Guo

doi:10.1155/2020/5259717

Abstract

Objective To analyze the types and properties of cystic lesions originating from the muscularis propria of the gastric cardia (CLMPGC), explore the growth pattern and anatomical characteristics, and evaluate the safety, feasibility, and clinical efficacy of endoscopic esophageal submucosal tunnel dissection (ESTD). Methods From September 2013 to July 2018, we treated 6 patients with CLMPGC whom we had diagnosed using endoscopy, endoscopic ultrasound (EUS), and Computed Tomography (CT) before the operations. ESTD was the best option for treatment for all these patients. Postoperative observation and follow-ups were performed, and the operational, clinical data, and treatment results are analyzed. Results The mean age of the patients was 50.67 ± 11.59 years (male : female = 1 : 1). The only clinical manifestations the patients exhibited were upper abdominal discomfort. The diameter of the masses was 2.05 ± 0.73 (1.1–3.0) cm. The duration of the ESTD operation was 93.5 (82–256) mins, and the length of hospital stay was 7.50 ± 1.38 days. Postoperative pathology showed 4 cases of an epithelioid cyst, and 2 cases of mucocele with xanthogranuloma. There were no complications, such as hemorrhage, pneumothorax, and pleural effusion during and after the operation. No recurrence during the follow-ups was observed. Conclusion The CLMPGC were mainly mucocele and epidermoid cyst, in an expansive growth pattern, and these lesions had no distinct borders with the muscularis propria. The muscularis propria formed a complete wall of the lesion. There was no direct blood supply to the lesions from big blood vessels. Endoscopic esophageal submucosal tunnel dissection was a safe, feasible, and effective treatment for CLMPGC.

Highlights

From September 2013 to July 2018, our team had treated 6 patients with CLMPGC. All these patients were diagnosed with CLMPGC by preoperative gastroscopy, endoscopic ultrasound (EUS), and Computed Tomography (CT); the lesions were confirmed to be originating from the muscularis propria of the gastric cardia
After the lesions had been localized by endoscopic ultrasonography, normal saline containing methylene blue and sodium hyaluronate was injected into the esophagus submucosa at 2 cm above the lesions. e submucosal space was established by the incision of the mucosa and submucosa, and the submucosa was dissected to expose the lesion along with the submucosal space. rough cutting the muscularis propria alongside the border of the lesion, we gradually dissected the lesion alongside its border
After searching lesions originating from the muscularis propria on PubMed [1,2,11,15,16,17,18,19,20], we have found a total of 532 report cases; among them, 76.69% (408/532) were leiomyomas, 22.18% (118/532) were stromal tumors, and 0.56% (3/532) were lipomas, while there was only 1 case of granular cell tumor, calcifying fibroma, schwannoma, and cystic lesion, respectively. us, we concluded that CLMPGC is a very rare and a benign disease

Summary

Objective

To analyze the types and properties of cystic lesions originating from the muscularis propria of the gastric cardia (CLMPGC), explore the growth pattern and anatomical characteristics, and evaluate the safety, feasibility, and clinical efficacy of endoscopic esophageal submucosal tunnel dissection (ESTD). Endoscopic esophageal submucosal tunnel dissection is an improved method of endoscopic minimally invasive treatment We have adopted this technique to treat a large number of lesions originating from the cardia’s muscularis propria and have achieved excellent clinical results. After diagnosing our first case of CLMPGC at our hospital in 2013, we successfully treated it with endoscopic esophageal submucosal tunnel dissection following the full assessment of the safety of this procedure. In the following 5 years, we have performed on another 5 cases of endoscopic submucosal tunnel dissection (ESTD) and evaluated the safety, feasibility, and clinical effects of ESTD in the treatment of CLMPGC

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