Endoscopic resection in subepithelial lesions of the upper gastrointestinal tract; experience of a tertiary referral hospital in The Netherlands.

Abstract

Objectives Histological confirmation of subepithelial lesions (SELs) in the upper gastrointestinal tract remains challenging. Endoscopic resection of SELs is increasingly used for its excellent diagnostic yield and opportunity to do away with continued surveillance. In this study, we aimed to evaluate the indications, success-rates and complications of different endoscopic resections techniques for SELs in a large, tertiary referral hospital in Rotterdam, The Netherlands. Methods Data between October 2013 and December 2021 were retrospectively collected and analyzed. Main outcomes are R0-resection rate, en bloc resection rate, recurrence rate and procedure-related adverse events (Clavien-Dindo). Secondary outcomes are procedure time, need for surgical intervention and clinical impact on patient management. Results A total of 58 patients were referred for endoscopic resection of upper gastro-intestinal SELs. The median diameter of lesions was 20 mm (range 7-100mm). Median follow-up time was 5 months (range 0.4-75.7). Forty-eight (83%) procedures were completed successfully leading to en bloc resection in 85% and R0-resection in 63%. Procedure-related adverse events occurred in 6 patients (13%). Severe complications (CD grade 3a) were seen in 3 patients. Local recurrence rate for (pre)malignant diagnosis was 2%. Additional surgical intervention was needed in 7 patients (15%). A total of 32 patients (67%) could be discharged from further surveillance after endoscopic resection. Conclusions Endoscopic resection is a safe and effective treatment for SELs and offers valuable information in undetermined SELs in which repeated sampling attempts have failed to provide adequate tissue for diagnosis.