Gastrointestinal Submucosal Tumors Research Articles

A Case of Gastrointestinal Submucosal Tumor Slightly Below the Cardia Treated by Single-Incision Laparoscopic Intragastric Resection

A Case of Gastrointestinal Submucosal Tumor Slightly Below the Cardia Treated by Single-Incision Laparoscopic Intragastric Resection

Analysis of the Efficacy and Safety of Different Endoscopic Surgery in Treatment of Upper Gastrointestinal Submucosal Tumors

Analysis of the Efficacy and Safety of Different Endoscopic Surgery in Treatment of Upper Gastrointestinal Submucosal Tumors

Fibrin sealant for closure of mucosal penetration at the oesophagus or cardia during submucosal tunnelling endoscopic resection for gastrointestinal submucosal tumours.

To assess the efficacy and safety of a fibrin sealant for the prevention of leak resulting from mucosal penetration at the esophagus or cardia during a STER procedure to remove gastrointestinal submucosal tumors (SMTs). Between April 2014 and October 2022, a total of 290 patients with oesophageal or cardiac SMTs underwent STER at our centre. We retrospectively identified patients with oesophageal or cardia SMTs who underwent STER and experienced mucosal penetration of the cardia or oesophagus during the procedure. A total of 31 mucosal penetrations in 30 procedures were included. Of the 31 mucosal penetrations, 12 occurred in the cardia, and the other 19 occurred in the oesophagus. All 31 sites received the fibrin sealant to close the mucosal penetration. Clinical characteristics, procedure-related parameters, detailed data of the mucosal penetrations, and treatment outcomes using the fibrin sealant were reviewed for all 30 patients to assess the efficacy and safety of the fibrin sealant for closure of mucosal penetration at the cardia or oesophagus. For the 31 mucosal penetrations, the mean size was 0.08 ± 0.06cm2 (range 0.01-0.25cm2). Mucosal closure using the fibrin sealant was performed successfully in all 31 mucosal penetrations. Of the 31 mucosal penetrations, clips were used in 13 cases. All 30 patients were discharged after a median of 7days (range 4-20day) postoperatively. During a mean 62months (range 6-107months) follow-up, all 31 mucosal penetrations successfully healed without the occurrence of infection, ulcer, oesophagitis, chest infection or abdominal infection. For the closure of mucosal penetration during STER at the cardia or oesophagus, a fibrin sealant is both safe and efficacious. It is necessary to conduct more research on the viability, effectiveness, and safety of using a fibrin sealant to close wider mucosal penetrations.

Enhancing gastrointestinal submucosal tumor recognition in endoscopic ultrasonography: A novel multi-attribute guided contextual attention network

Endoscopic ultrasonography (EUS) is a valuable imaging modality for diagnosing gastrointestinal submucosal tumors (SMTs). However, inherent content variations in EUS images due to gastrointestinal tract mobility and handheld ultrasound instability challenge the saliency of SMTs’ visual features. The presence of fine-grained inter-class and large intra-class differences further complicates EUS-based diagnosis. To address these issues, this paper presents a novel Multi-Attribute Guided Contextual Attention Network (MAG-CA-Net) for interpretable SMT recognition in EUS. Inspired by endoscopists’ clinical diagnosis expertise, our framework initially localizes abnormal areas based on echo attributes and subsequently determines tumor categories using contextual semantics. Experimental results demonstrate the effectiveness of MAG-CA-Net, exhibiting improved recognition recall and precision rates for gastrointestinal stromal tumor, leiomyoma, and pancreatic rest. Specifically, the MAG network facilitates abnormal area localization, while the CA mechanism guides the model to focus on the most discriminative tumor-context-associated regions. The proposed method achieved an average classification accuracy of 93.16%, an average precision of 93.17%, a weighted recall of 93.16%, and an average F1-score of 93.15 % for the three disease categories. The proposed approach provides crucial guidelines for data collection standards and model development in the clinical diagnosis process of SMTs under EUS. Its interpretability analysis enhances the credibility of clinical physicians towards assisted diagnostic methods based on deep learning. The source code will be publicly available at https://gitee.com/HangbinZheng/mag-ca-net.

Gastrointestinal Subepithelial Lesions: A Review

AbstractSubmucosal lesions, also known as subepithelial lesions, are often encountered during endoscopy of the gastrointestinal tract. Most of the lesions are asymptomatic and can be diagnosed by routine endoscopic ultrasonography. Few lesions like gastrointestinal submucosal tumors (GIST) and leiomyoma require biopsy/fine-needle aspiration cytology (FNAC) for differentiation. Lesions like neuroendocrine tumors can be diagnosed by deep endoscopic biopsy as they originate from the inner mucosal layer. Management depends on the size and layer of origin of the lesion. Smaller lesions can be removed by endoscopic procedures and bigger lesions by surgery. Smaller lesions can be safely surveilled.

Risk factors for complications of endoscopic full-thickness resection of upper gastrointestinal submucosal tumors

Objective: To analyze the risk factors for complications of endoscopic full-thickness resection (EFTR) of upper gastrointestinal submucosal tumors (SMTs). Methods: This was a retrospective observational study. The indications for EFTR included: (1) SMTs originating from the muscularis propria layer and growing out of the cavity or infiltrating the deep part of the muscularis propria layer; (2) SMTs diameter <5 cm; and (3) tumor identified as closely adherent to the serous layer during endoscopic submucosal dissection or endoscopic mucosal resection. This study included patients with SMTs originating from the muscularis propria layer in upper digestive tract, diagnosed preoperatively by endoscopic ultrasonography or computed tomography, who were successfully treated with EFTR. Those with incomplete clinical data were excluded. The clinical data of 154 patients with upper gastrointestinal SMTs who underwent EFTR at the Department of Gastroenterology, First Affiliated Hospital of Soochow University from January 2016 to January 2022 were retrospectively analyzed. Post-EFTR complications (such as delayed perforation, delayed bleeding, and postoperative infection, including electrocoagulation syndrome) were monitored and the risk factors for them were analyzed. Results: Among the 154 study patients, 33 (21.4%) developed complications, including delayed bleeding in three (1.9%), delayed perforation in two (1.3%), and postoperative infection in 28 (18.2%). One patient with bleeding was classified as having a major complication (hospitalized for more than 10 days because of complication). According to univariate analysis, complication was associated with tumor diameter >15 mm, operation time >90 minutes, defect closure method(purse string suture), and diameter of resected specimen ≥20 mm (all P<0.05). Multivariate logistic regression analysis showed that operation time >90 minutes (OR=6.252, 95%CI: 2.530-15.446, P<0.001) and tumor diameter >15 mm (OR=4.843, 95%CI: 1.985-11.817, P=0.001) were independent risk factors for complications after EFTR in patients with upper gastrointestinal SMTs. The independent risk factors for postoperative infection in these patients were operation time>90 minutes (OR=4.993, 95%CI:1.964-12.694, P=0.001) and purse string suture (OR=7.142, 95%CI: 1.953-26.123, P=0.003). Conclusion: Patients with upper gastrointestinal SMTs undergoing EFTR with tumor diameter >15 mm or operation time >90 minutes have a significantly increased risk of postoperative complications. Postoperative monitoring is important for these patients with SMTs.

Endoscopic full‑thickness resection with clip‑ and snare‑assisted traction for gastric submucosal tumours in the fundus: A single‑centre case series.

Exposed endoscopic full-thickness resection (Eo-EFTR) has been recognized as a feasible therapy for gastrointestinal submucosal tumours (SMTs) originating deep in the muscularis propria layer; however, Eo-EFTR is difficult to perform in a retroflexed fashion in the gastric fundus. As a supportive technique, clip- and snare-assisted traction may help expose the surgical field and shorten the operation time in endoscopic resection of difficult regions. However, the application of clip- and snare-assisted traction in Eo-EFTR of SMTs in the gastric fundus is limited. Between April 2018 and December 2021, Eo-EFTR with clip- and snare-assisted traction was performed in 20 patients with SMTs in the gastric fundus at The First Affiliated Hospital of Soochow University. The relevant clinical data were collected retrospectively for all of the patients and analysed. All 20 patients underwent Eo-EFTR successfully without conversion to open surgery or severe adverse events. The en bloc resection rate and R0 resection rate were both 100%. Two patients had abdominal pain and fever after the operation, and five patients had fever, which recovered with medical therapy. No complications, such as delayed bleeding or delayed perforation, were observed. The postoperative pathology indicated that 19 cases were gastrointestinal stromal tumours and one case was leiomyoma. During the follow-up, no residual tumour, local recurrence or distant metastasis was detected by endoscopy or abdominal computed tomography. In conclusion, Eo-EFTR with clip- and snare-assisted traction appears to be a relatively safe and effective treatment for gastric SMTs in the fundus. However, prospective studies on a larger sample size are required to verify the effect of the clip- and snare-assisted traction in Eo-EFTR.

Risk stratification in patients with upper gastrointestinal submucosal tumors undergoing submucosal tunnel endoscopic resection.

A substantial heterogeneity exists in patients with upper gastrointestinal submucosal tumors (SMTs). This study aimed to identify predictors of long procedure time (≥60 min), occurrence of procedure-related complications, and long hospital stay (≥6 days) in patients with SMTs undergoing submucosal tunnel endoscopic resection (STER) and stratify risk based on the predictors. Sixty-six consecutive patients with upper gastrointestinal SMTs undergoing STER between January 2013 and December 2018 were retrospectively included. Binary logistic regression models were developed to identify predictors of outcomes. Receiver operating characteristic (ROC) curves were constructed to evaluate the discrimination of tumor size. Complete resection and en bloc resection of tumor were achieved in 66 (100%) and 64 patients (97%), respectively. Twenty-seven patients (41%) had a long procedure time, 10 (15%) developed STER-related complications, and 17 (26%) had a long hospital stay. On multivariable analysis, tumor size was an independent predictor of long procedure time (OR 1.37, 95% CI 1.13-1.67; p = 0.001), occurrence of complications (OR 1.06, 95% CI 1.01-1.10; p = 0.012), and long hospital stay (OR 1.05, 95% CI 1.01-1.09; p = 0.035). ROC curves identified a tumor of size 25 mm as the best cutoff; those who had a tumor above this value had a 76-fold risk of long procedure time, 8.56-fold risk of occurrence of complications, and 6.35-fold risk of long hospital stay. Patients with a tumor size ≥25 mm had longer procedure time, higher risk of STER-related complications, and longer hospital stay; therefore, they should be classified as a high-risk group.

S3687 Unusual Cause of Bleeding From an Underlying Glomus Tumor

Introduction: Glomus tumors (GTs) are rare, mostly benign mesenchymal neoplasm accounting for nearly 1% of all gastrointestinal soft tissue tumors. Commonly seen in distal extremities, they do rarely occur in the gastrointestinal tract where it most commonly involves the stomach, especially the antrum. These tumors lack specific symptoms and endoscopic findings making it hard to differentiate from other gastrointestinal submucosal tumors without resection. We present a rare case of gastric glomus tumor (GGT) in the antrum diagnosed in a patient presenting with melena. Case Description/Methods: 47-year- old male patient presented with melena. Upper endoscopy revealed a non-bleeding gastric ulcer with a visible vessel. Almost 3 cm submucosal lesion was seen at the site of the ulcer concerning for possible hematoma. Given the size of the lesion a follow up CT scan was performed 2 months later which showed persistent 3 cm submucosal circumscribed hyper enhancing lesion at the pylorus. The patient was then scheduled for endoscopic ultrasound which showed a hypoechoic lesion with discrete borders arising from the muscularis propria measuring 22 × 24 mm in maximal dimension. Fine needle biopsy of the lesion was performed using 22-gauge needle. Pathology revealed uniform round cells intimately associated with gaping vessels. The cells were reactive for vimentin and smooth muscle actin consistent with the diagnosis of glomus tumor. The patient was referred to surgery for excision (Figure 1). Discussion: Glomus tumor of the stomach arise from the intramuscular layer and often present as a solitary submucosal lesion. GGTs usually present with epigastric discomfort, hematemesis, melena, nausea or vomiting or rarely as an incidental finding. Endoscopic ultrasound typically shows hypoechoic circumscribed lesions mostly arising from the fourth layer of the stomach. However biopsies are rarely conclusive thus making preoperative diagnosis challenging. Given its rare malignant potential, wide local surgical excision is the treatment of choice.Figure 1.: Endoscopic ultrasound of a glomus tumor in the gastric antrum. Figure 2: Upper endoscopy of a glomus tumor with a central ulcer and visible vessel.

Routine nasogastric tube placement after gastric endoscopic full-thickness resection of tumor size ≤ 2cm may be unnecessary: a propensity score-matching analysis.

Endoscopic full-thickness resection is a common endoscopic procedure for treating gastrointestinal submucosal tumors. Nasogastric tube placement is frequently performed after abdominal surgery, but the routine use of this approach remains controversial. The aim of this research was to explore whether nasogastric tube placement after gastric endoscopic full-thickness resection is necessary. A retrospective study enrolled patients who underwent gastric endoscopic full-thickness resection in our hospital between January 2014 and January 2019, and all the patients had a tumor size ≤ 2cm. The patients were divided into two groups according to whether a nasogastric tube was placed. Postprocedural adverse events and hospital stay duration were compared between the two groups using 1:1 propensity score matching. A total of 461 patients were enrolled in this study, including 385 patients in the nasogastric tube group (NGT group) and 76 patients in the non-nasogastric tube group (non-NGT group). After matching, the baseline characteristics of 73 patients in the NGT group and 73 patients in the non-NGT group were balanced (p > 0.05). The postprocedural fever rate in the NGT group was significantly higher than that in the non-NGT group (23.3% vs. 9.6%, p = 0.044). 6.9% (5/73) of patients experienced severe nasogastric tube-related throat discomfort. However, the duration of hospitalization stay was not different between the two groups. For patients with tumor size ≤ 2cm, routine nasogastric tube placement after gastric endoscopic full-thickness resection may be unnecessary.

Submucosal Tunneling Endoscopic Resection for Submucosal Tumors in the Proximal Esophagus.

Submucosal tunneling endoscopic resection (STER) is widely applied for treatment of gastrointestinal submucosal tumors (SMTs) originating from the muscularis propria layer. However, the tumor location within the proximal esophagus makes STER a challenge for the endoscopists. The aim of this study was to summarize the technique skill and evaluate the outcomes of proximal esophageal STER. A total of 72 patients with SMTs in the proximal esophagus undergoing STER were included from February 2019 to March 2021. Imaging 3-dimensional reconstruction was used for patients with large SMTs. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. In this study, all the tumors were removed completely and no gross disease was remaining. The en bloc resection was achieved in 90.28% of patients, and the complications rate was 6.95%. Three-dimensional reconstruction was used for 30 patients (41.67%) with large SMTs (transverse diameter >2.0 cm). Based on statistical analysis, tumors with irregular shape and larger size were the significant contributors to piecemeal resection. Larger tumors increase the risk of long operation time, and irregular tumor shapes increase the risk of complications. The median hospitalization time was 4 days. All of the complications were cured by conservative treatment. A median follow-up of 12 months was available, and all patients were free from local recurrence or distant metastasis during the study period. STER is an effective and safe methodology for the resection of proximal esophageal SMTs. Tumor size and shape mainly impact the piecemeal resection rate, STER-related complications, and procedural difficulty.

Exposed endoscopic full-thickness resection for duodenal submucosal tumors: Current status and future perspectives.

Exposed endoscopic full-thickness resection (EFTR), with or without laparoscopic assistance, is an emergent natural orifice transluminal endoscopic surgery technique with promising safety and efficacy for the management of gastrointestinal submucosal tumors (SMTs) arising from the muscularis propria (MP), especially of the gastric wall. To date, evidence concerning duodenal exposed EFTR is lacking, mainly due to both the technical difficulty involved because of the special duodenal anatomy and concerns about safety and effectiveness of transmural wall defect closure. However, given the non-negligible morbidity and mortality associated with duodenal surgery, the recent availability of dedicated endoscopic tools for tissue-approximation capable to realize full-thickness defect closure could help in promoting the adoption of this endosurgical technique among referral centers. The aim of our study was to review the current evidence concerning exposed EFTR with or without laparoscopic assistance for the treatment of MP-arising duodenal SMTs.

Endoscopic resection of a rectal gastrointestinal stromal tumor using the submucosal tunneling endoscopic resection (STER) technique.

The optimal treatment for a gastrointestinal stromal tumor (GIST) of the rectum is controversial owing to its extremely low incidence [1]. The submucosal tunneling endoscopic resection (STER) technique is a so-called “nonexposed” full-thickness endoscopic resection technique developed to remove upper gastrointestinal submucosal tumors (SMTs) arising from the muscularis propria [2] [3]. This technique allows a very interesting exposure of a GIST, as the axis of the knife is more tangential than when using an “exposed ESD technique”, which features a perpendicular axis that carries a risk of R1 resection. We believe that it could also be interesting for the resection of rectal SMTs. We report here the first successful use of this technique, with an accompanying video ([Video 1]), for the removal of a 15-mm rectal GIST.

Submucosal tunneling endoscopic resection treatment of multiple gastrointestinal submucosal tumors.

Gastrointestinal submucosal tumors (SMTs) can be removed by submucosal tunneling endoscopic resection (STER). However, limited studies have evaluated STER for the removal of multiple upper gastrointestinal SMTs. The aim of this study was to evaluate the feasibility and outcomes of STER in the treatment of multiple upper gastrointestinal SMTs. From January 2011 to April 2020, the cases of patients with multiple upper gastrointestinal SMTs undergoing STER were retrospectively analyzed. Variables of clinicopathological characteristics, major adverse events (mAEs), and follow up were collected and analyzed. Submucosal tunneling endoscopic resection was performed in 54 patients (48 male and 6 female patients) with 120 SMTs. Forty-four patients had two tumors, eight patients had three tumors, and two patients had four tumors. The median size of each patient was 1.8cm (range 0.7 to 3.5cm). Forty-five patients had tumors removed by one tunnel, and nine patients by two tunnels. The median procedure time was 50min (range 14 to 120min), and the mAE rate was 16.7% (9/54). No significant differences were found between patients with two tumors and those with >2 tumors in terms of tunnel length, hospital stay, procedure time, and mAEs (all P>0.05). In addition, patients with two tunnels had procedure time, hospital stay, and mAE rates comparable with those with one tunnel (all P>0.05). No local recurrence or distant metastasis occurred during a median follow up of 64months. Submucosal tunneling endoscopic resection is a safe and effective technique for the resection of multiple upper gastrointestinal SMTs.

Submucosal tunneling endoscopic resection of an exogenic esophageal mass in the mediastinum (with video).

Submucosal tunneling endoscopic resection (STER) for the treatment of upper gastrointestinal submucosal tumors originating from the muscularis propria was first introduced by Xu et al. [1] in 2012. It has been demonstrated to be safe and effective for treating small (<3.5 cm) esophageal leiomyoma. However, sometimes the esophageal leiomyoma may be a giant mass and protrude into the mediastinum. It is uncertain whether STER can be used to resect the mass in the mediastinum. In this case, we successfully carried out STER in a patient with giant leiomyoma protruding into the mediastinum.

Gastrointestinal exposed endoscopic full-thickness resection in the era of endoscopic suturing: a retrospective single-center case series.

IntroductionExposed endoscopic full thickness resection (EFTR) is a minimally invasive technique that has shown promising efficacy and safety in the removal of both gastrointestinal (GI) submucosal tumors (SMTs) arising from the muscularis propria (MP) and select epithelial tumors (ETs) unsuitable for conventional resection techniques. Given the chance of realizing endosurgical full-thickness suturing, the Endoscopic Suturing System (ESS) can be used to close wall defects in this setting. However, data concerning its use in EFTR are still limited.AimThis study was conducted to evaluate the safety and efficacy of exposed EFTR with defect closure using the ESS for the removal of both GI SMTs and select ETs unsuitable for conventional resection techniques.Material and methodsThis was a retrospective, single-center, observational cohort study of patients who underwent GI exposed EFTR.ResultsSeven patients (M : F 6 : 1) with a mean age of 56 ±14.5 years were identified. The indications were MP-originating SMTs of the stomach (n = 2) and duodenum (n = 2), and from submucosa of the rectum (n = 1), and 2 ETs of the rectum. Exposed EFTR and defect closure were successfully performed in 6/7 patients. One case was converted to laparoscopic gastric wedge resection due to technical unfeasibility. We performed an R0 resection in all cases, with the exception of 1 case of rectal EFTR. No macroscopic recurrence was detected at 6-month endoscopic follow-up.ConclusionsGI exposed EFTR with defect closure by the ESS appears to be feasible, effective, and safe in referral centers. Further studies are necessary to clarify the role of the ESS for post-EFTR wall defect closure.

A Novel Snare Traction-Assisted Method During Endoscopic Resection for Upper Gastrointestinal Submucosal Tumors.

Background: Traction-assisted endoscopic resection is an approach to provide better procedural outcomes than conventional endoscopic procedure in treating gastric or esophageal epithelial lesions. Submucosal tumors (SMTs) are challenging to resect endoscopically due to the difficulty in exposure and high incidence of full-thickness resection. In this study, we investigated the efficacy of snare traction-assisted method, served as an "extra hand," for upper gastrointestinal SMTs. Methods: From June 2019 to May 2020, we used the snare traction-assisted method to treat 11 patients with 12 upper gastrointestinal SMTs in the Sixth Affiliated Hospital, Sun Yat-sen University. The duration of the procedures and the outcomes were recorded. Results: A total of 11 patients with 12 lesions were treated by snare traction-assisted endoscopic resection. The mean procedure time was 26.8 ± 8.3 minutes. En bloc resection was achieved in all the 12 lesions. The mean length of the specimens was 11.5 ± 4.0 mm. Full-thickness resection was performed in four lesions. The patients were discharged in 5.0 days after procedures without delayed bleeding or other complication reported. Conclusion: Snare traction-assisted method is an effective tool for endoscopic resection of upper gastrointestinal SMTs. Further prospective studies comparing the snare traction-assisted method with the conventional procedure are necessary.

Su1293 NON-INVASIVE DIAGNOSTIC METHOD OF GASTRIC SUBMUCOSAL TUMORS USING CIRCULARITY OF LESIONS: A RETROSPECTIVE ANALYSIS IN 44 CASES

Gastrointestinal submucosal tumor (SMT) shown as a hypoechoic mass lesion in endoscopic ultrasonography (EUS) mainly includes gastrointestinal stromal tumor (GIST), leiomyoma and schwannoma, and it is difficult to distinguish them by using imaging modalities. Although EUS-guided fine-needle aspiration is a standard option to diagnose SMTs, that is more or less invasive and sometimes less satisfactory due to insufficient amount of obtained tissue. Therefore, a new non-invasive and more reliable diagnostic method is still desired. We hypothesized that gastric SMTs could be discriminated by comparing a shape of lesions in EUS images, because leiomyomas generally appeared craggy whereas the others were roundish. Therefore, this study aimed to investigate diagnostic ability in circularity of SMTs, a surrogate indicator of roundness calculated as four pi times the area divided by the perimeter squared (0–1, 1 = a true circle). A total of 44 gastric SMTs 20–45 mm in diameter, which had been surgically removed after evaluation with EUS and finally diagnosed as GIST, leiomyoma or schwannoma between January 2010 and December 2018, were retrospectively collected at two institutions. In each lesion, one EUS still image showing the maximal area was selected. Then, two endoscopists who did not know histological diagnosis evaluated the circularity in three times per lesion by using ImageJ (ver. 1.50e; National Institutes of Health, USA), and mean circularity were compared among the three groups. Subsequently, a cut-off value was calculated by investigating a receiver operating characteristics (ROC) curve in groups with a significant difference. We also investigated an interobserver agreement between two evaluators. In 44 SMTs, GIST, leiomyoma, and schwannoma were 31, 8, and 5, respectively. Mean circularity in these three groups were 0.86 ± 0.74, 0.69 ± 0.82 and 0.89±0.57, respectively, with a statistical significance (p <0.01). The mean circularity in leiomyoma was significantly lower than that of GIST and schwannoma (p<0.01) whereas there were no significant difference between GIST and schwannoma (p = 0.054). When a cut-off value was set at 0.82, the area under ROC curve for predicting leiomyoma was 0.935 with 81.9% of sensitivity and 93.7% of specificity. Regarding the interobserver agreement, a kappa value was 0.78 (p <0.01). This retrospective pilot study suggests that circularity of SMTs calculated by using EUS still images may be useful as a non-invasive and reliable diagnostic indicator to distinguish leiomyoma from other mesenchymal tumors with high accuracy and reproducibility. To reconfirm and establish this diagnostic strategy, a large-numbered, prospective study is required.

Submucosal tunneling endoscopic resection for large symptomatic submucosal tumors of the esophagus: A clinical analysis of 24 cases

Studies evaluating submucosal tunneling endoscopic resection (STER) for the treatment of upper gastrointestinal submucosal tumors (SMTs) have recently increased. However, the efficacy and safety of STER for the treatment of large symptomatic SMTs in the esophagus have not been well investigated. The aim of the present study was to evaluate the efficacy and safety of STER for the treatment of large symptomatic SMTs in the esophagus. A total of 24 patients with large symptomatic SMTs in the esophagus who underwent STER in our hospitals between January 2015 and May 2018 were included in the study. The tumors were confirmed to be of muscularis propria layer origin. Treatment outcomes, complications, and follow-up results were retrospectively analyzed. All 24 lesions were resected en bloc with STER. The mean maximum transverse diameter of the lesions was 4.7 (3.5-6.5) cm. The mean maximum longitudinal diameter of the lesions was 2.1 (1.5-3.0) cm. The mean duration from mucosal incision to complete mucosal closure was 65 (50-115) min. Postoperative pathological diagnosis confirmed 18 cases with leiomyomas, 4 cases with stromal tumors, and 2 cases with schwannomas. There were no major complications. There were no residual lesions or disease recurrence during follow-up. STER is safe and effective for the treatment of large symptomatic SMTs of muscularis propria layer origin in the esophagus.

Comparing about three types of endoscopic therapy methods for upper gastrointestinal submucosal tumors originating from the muscularis propria layer

Background: Endoscopic submucosal excavation (ESE), endoscopic full-thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) have been widely applied to upper gastrointestinal submucosal tumors (SMTs) originating from the muscularis propria (MP) layer in recent years. But until now, there are few studies that comparing the efficacy and safety of three endoscopic therapy methods.Method: From January 2013 to August 2018, a total of 218 patients with SMTs who underwent ESE, EFTR or STER were enrolled in this retrospective study. Clinicopathological characteristics, endoscopic features, complication and follow-up data were analyzed.Result: There were 114 patients underwent ESE, 61 underwent EFTR and 43 underwent STER, respectively. The en bloc and complete resection rates in STER group (83.7% and 90.0%) were significantly lower and postoperative complication rate (62.8%) was significantly higher than those of the other 2 methods. Furthermore, for lesions <40 mm, no significant differences were found in the en bloc rate, complete rate and postoperative complication rate among 3 methods. The perforation rate decreased in the order of EFTR (100%), ESE (23.7%), STER (7.0%). The median number of clips, fasting time and hospital stay were lowest in ESE group (5, 2 days, and 7 days). And the cost was highest in EFTR group ($4993.1). There were no differences in the bleeding and recurrence rates among three groups.Conclusion: For SMTs <40 mm, the efficacy among 3 ER methods are comparative. The choice of ER methods mainly based on the comprehensive consideration of lesion size, location, growth pattern and clinical experience of endoscopists. For benign SMTs ≥40 mm in stomach, ESE and EFTR becomes alternative choices.