Key issues about the endoscopic treatment for upper gastrointestinal submucosal tumors

Abstract

Objective To investigate the necessity and selection of endoscopic treatment in patients with upper gastrointestinal submucosal tumors (SMTs). Methods Clinical data of 306 patients with upper gastrointestinal SMTs at the Digestive Endoscopy Center of Shanghai Changhai Hospital from January 2012 to October 2013 were reviewed, and distribution characteristics, pathology types, endoscopic operation option of SMTs were analyzed. Results Of all 306 cases, 55 lesions (18.0%) were located in esophagus, 244 (79.7%) in stomach, 7 (2.3%) in duodenum. Pathological results showed that there were 142 cases (46.4%) of leiomyoma, 114 (37.3%) gastrointestinal stromal tumors (GIST), 15 (4.9%) ectopic pancreas, 14 (4.6%) lipomas, 7 (2.3%) neuroendocrine tumors (NETs), and 14 (4.6%) other types. Of esophageal SMTs, leiomyoma accounted for 85.4%, GIST 5.4%. Of cardiac SMTs, leiomyoma was 78.8%, GIST was 12.1%. Of gastric fundus SMTs, leiomyoma was 28.7%, GIST was 69.0%. Of gastric body SMTs, leiomyoma was 38.6%, GIST was 45.5%. Of gastric antrum SMTs, leiomyoma was 25.7%, GIST was 14.3%. Of duodenal SMTs, leiomyoma was 14.3%, GIST was 28.6%. Of all 306 cases, 242 cases(79.1%) received ESE, 28 cases(9.2%) received STER, 25 cases(8.2%) received EFR. Of esophageal operations, ESE was 54.5%, STER was 40%. Of gastric operations, ESE was 84.4%, STER was 2.5%, EFR was 10.2%. All duodenal patients received ESE. STER was mainly used in esophagus (78.6%), and EFR was mainly used at gastric fundus (72.0%) and body (24.0%). Conclusion Regular endoscopic follow-up could be a good option for SMTs located in esophagus, gastric cardiac and antrum, which are mostly benign lesions, especially when no obvious symptoms develop. Endoscopic therapy should be recommended for SMTs located in gastric fundus and body, which are mostly GISTs. STER may be more safe and effective for esophageal SMTs, but not suitable for giant lesions. ESE is the major operation for gastric SMTs, while EFR is more suitable for deep-origin lesions, especially in fundus and body. ESE is the major mode for duodenal SMTs. However, laparoscopic or surgical treatment should be considered when endoscopic treatment is difficult or risky. Key words: Gastrointestinal neoplasms; Endoscopes, gastrointestinal; Pathology; Therapy