Sa2049 ENDOSCOPIC RESECTION FOR LEIOMYOMA OF SUBMUCOSAL TUMORS ORIGINATING FROM THE MUSCULARIS PROPRIA LAYER IN THE ESOPHAGOGASTRIC JUNCTION

Abstract

The lesions in esophagogastric junction (EGJ) are difficult for treatment. The operative resection of the gastric cardia causes the diminishment of quality of life. The endoscopic treatment has been developed for the resection of submucosal tumors (SMTs). The techniques of endoscopic resection for the SMTs originating from the muscularis propria (MP) layer mainly include endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER). The safety and efficacy of ESD and STER for EGJ SMTs has been demonstrated. We found most SMTs in EGJ are leiomyomas. The aim of the investigation was to evaluate the characteristics of leiomyomas of SMTs originating from the MP layer in EGJ by endoscopic resection. 32 patients with SMTs of the EGJ originating from the MP layer underwent ESD or STER were analyzed between March 2019 and November 2019 in a single academic medical center. The SMTs had been confirmed to be leiomyoma by pathologic evaluation .Size, adverse events, and en bloc resection rate were evaluated. 19 (59.4%) were female;17 (53.1%) were <50 years old; 19 (59.4%) underwent ESD and 13 (40.6%) underwent STER. The average maximum diameter of the lesions was 26.8 mm (range 6–90 mm). The en bloc resection rate was 93.75 % (30/32). No delayed hemorrhage or severe adverse events occurred in any of the patients following ESD. The patient with the largest tumor (90mm) which showed predominantly extraluminal growth required emergency surgery for severe bleeding in STER group. The patients with SMTs larger than or equal to 30mm were younger compared to the ones with SMTs less than 30mm (41 vs.52.6, p<0.05). The patients with leiomyomas originating from the MP layer especially larger than 30mm were young. Our study showed that endoscopic resection (ESD or STER) was safe, effective and minor invasive for the treatment of leiomyomas originating from the MP layer in the EGJ, but it seemed the large tumors with predominantly extraluminal growth should be considered prudently.