Muscularis Propria Layer Research Articles

Esophageal Leiomyoma Originating in the Muscularis Propria Layer Resected by Endoscopic Submucosal Dissection

Esophageal Leiomyoma Originating in the Muscularis Propria Layer Resected by Endoscopic Submucosal Dissection

Laparoscopy-assisted endoscopic full-thickness resection for gastric subepithelial tumors originated from the muscularis propria layer: a pilot study with literature review

Objective: Laparoscopy-assisted endoscopic full-thickness resection (LAEFTR) has been suggested as an alternative to laparoscopic wedge resection in the treatment of gastric subepithelial tumors (SETs). It is expected to minimize the resection of the tissue surrounding the tumors and maintain the function of the remnant stomach. Here, we performed a prospective pilot study to evaluate the efficacy of laparoscopy-assisted endoscopic full-thickness resection (LAEFTR) for patients with gastric SETs.Material and methods: We enrolled twelve patients who were diagnosed with gastric SETs with an intraluminal growth pattern or which is located in the gastric antrum between October 2011 and September 2013. LAEFTR was performed endoscopically using an endoscopic knife to make an incision half way around the tumor circumference and a laparoscopic resection around the remaining tumor circumference, followed by its laparoscopic removal. The feasibility, safety, and effectiveness of LAEFTR for gastric SETs were evaluated.Results: The median size of the tumors in twelve patients was 22 mm (21–33). Of the 12 patients, 8 received LAEFTR, while the others underwent conventional laparoscopic wedge resection, since their tumor outlines were clearly visible in laparoscopic view. In 8 patients who underwent LAEFTR, the mean total operation time (endoscopic procedure time/laparoscopic procedure time) were 117 (37/41) min. The tumors were completely resected with clear margin, and there was no perioperative and postoperative complications.Conclusions: LAEFTR currently seems to be the ideal treatment modality of intraluminal gastric SETs where their resection margins are difficult to define under laparoscopic guidance alone.

EUS-assisted endoscopic trepanned resection-closure of small gastric stromal tumors originating from the muscularis propria layer

Objective To evaluate the safety and effectiveness of EUS-assisted endoscopic trepanned resection-closure of small gastric stromal tumors originating from the muscularis propria layer. Methods Data of 61 patients with small gastric stromal tumors originating from the muscularis propria layer treated by EUS-assisted endoscopic trepanned resection-closure were retrospectively studied for operation completion, complication and follow-up results. Results All 61 patients with lesions of 5 to 12 mm in diameter achieved complete excision in one procedure by gastric wall full-thickness resection, with operation time of 25-45 min. Perforation was successfully closed with titanium clips after fastened in advance with only minor hemorrhage during surgery, and no hemorrhage occurred after the operation. The average length of hospitalization was 5-7 days. Pathology confirmed 61 cases of extremely low-grade or low-grade malignant gastrointestinal stromal tumors. The patients were followed up for 1 to 27 months, and no tumor residue or recurrence was observed. Conclusion It is safe and effective to use EUS-assisted endoscopic trepanned resection-closure, which could not only get the accurate pathologic diagnosis but also meet requirement of complete excision of small gastric stromal tumors originating from the muscularis propria layer. Key words: Ultrasonic endoscope; Endoscopic trepanned resection-closure; Gastric stromal tumors

Comparison of Clinical Outcomes of ESD vs STER for Esophagus, Esophagogastric Junction, and Gastric Tumor (Cancer) Originating from the Muscularis Propria Layer: A Systematic Review and Pooled Analysis

Comparison of Clinical Outcomes of ESD vs STER for Esophagus, Esophagogastric Junction, and Gastric Tumor (Cancer) Originating from the Muscularis Propria Layer: A Systematic Review and Pooled Analysis

Dysphagia and Food Impaction: An Unexpected Etiology

Malignant pseudoachalasia is a rare disease that presents with similar radiographic and manometric features as primary achalasia; however their clinical presentation may vary. Pseudoachalasia usually occurs in advanced age individuals with an acute onset and significant weight loss. This is the case of an 83-year-old man with a medical history of atrial fibrillation on chronic anticoagulation with warfarin, chronic kidney disease stage three and ischemic cerebrovascular accident, who was evaluated due to progressive dysphagia to solid food of four months in evolution. Three days prior to evaluation, the patient had an episode of food impaction after a solid meal in which he wasn't able to tolerate neither water nor his own pills. Symptomatology progressed developing nausea and vomiting of undigested food contents as well as a ten pound weight loss. Initial laboratories revealed normochromic, normocytic anemia and pre-renal azotemia. Chest computed tomography (CT) revealed dilation of esophagus with retained debris consistent with food impaction. Esophagogastroduodenoscopy revealed evidence of food impaction at mid esophagus, removed with overtube assistance for airway protection using a basket and Roth net. Upon stomach inspection, a mass like ulceration was observed at the distal body of the stomach, multiple biopsies were obtained, which latter confirmed moderately differentiated invasive gastric adenocarcinoma. Endoscopic ultrasound showed a hypoechoic lesion with infiltration of submucosa and muscularis propria layer of the gastric wall. without lymphadenopathies, for a tumor staging of T2N0M0. PET/CT showed no metastasis. Barium swallow revealed a proximal dilation with distal narrowing consistent with achalasia. Manometry was remarkable for aperistalsis and increased lower esophageal sphincter resting pressure. Anti-neuronal nuclear antibodies, Anti-Hu and Anti-Ach were normal. Final diagnosis of pseudoachalasia secondarily to infiltrative gastric adenocarcinoma causing myenteric plexus dysfunction at muscularis propria on distal body was made. Rare etiology since most common cause of pseudoachalasia is compression of the esophagus by an extraluminal mass at fundus or cardia. Due to poor functional status patient wasn't a surgical candidate and was started on chemotherapy with 5FU and cisplatin.

Myofibroblasts of the muscle layer stimulate the malignant potential of colorectal cancer.

Myofibroblasts of colorectal cancer (CRC) have been associated with histopathological factors such as lymph node metastasis, liver metastasis and local recurrence. However, few studies have assessed the association between these malignant potentials and the myofibroblast distribution in CRC. We aimed to evaluate the relationship between clinical factors and myofibroblast distribution around CRC invasive lesions. The study included 121 cases of pT3 CRC that were diagnosed at stage II or III. Myofibroblast density of the following three histological layers was measured: the submucosa (SM), muscularis propria (MP) and subserosa (SS). We analyzed the relationship between the clinicopathological factors and myofibroblast density by studying the histopathological features of the three layers. The myofibroblast density of the MP layer was significantly higher in the groups with high-frequency lymphatic and venous invasion than the groups with low-frequency lymphatic (P<0.001) and venous (P<0.01) invasion, respectively. In the positive lymph node metastasis group, the myofibroblast density at the MP layer was significantly higher than that in the negative lymph node metastasis group (P<0.001). The high myofibroblast density group at the MP layer was significantly associated with poor overall survival (P<0.003). Our study indicated that myofibroblasts are a type of cancer-associated fibroblasts and that the myofibroblast distribution contributes to the malignant potential of CRC. Furthermore, we demonstrated that myofibroblasts present at the MP layer play an important role in the malignant potential and poor prognosis of patients with CRC.

Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases.

Endoscopic removal of a duodenal lesion is still considered to be a challenging procedure that can be fraught with potentially serious complications, specifically perforation or delayed bleeding. This study was to assess the safety of endoscopic resection for duodenal subepithelial lesions (SELs) with wound closure using clips and an endoloop. From October 2010 to July 2015, a total of 68 consecutive patients with duodenal SELs were treated with endoscopic resection with wound closure using clips and an endoloop. The main outcome measures considered were the incidence of complete resection, perioperative perforation, delayed perforation, delayed bleeding, residual lesions, and lesion recurrence. Complete resection was successfully achieved for all 68 patients. The median lesion size was 1.7cm. The median procedure time was 62min. The mean hospital stay was 5.5days. During the procedure, five patients developed perioperative perforations (7.4%) and no patients developed delayed bleeding, delayed perforation, or other serious complications. The five patients with perioperative perforations recovered after conservative treatment. The perioperative perforation rate was significantly higher for lesions originating in the muscularis propria layer (18.2%) than in the submucosal layer (2.2%; p<0.05). No residual or recurrent lesions were detected during the follow-up period (median: 27months). Endoscopic resection with wound closure using clips and an endoloop is an effective and reasonably safe therapeutic method for treating/removing duodenal SELs when managed by an experienced endoscopic team, and it can provide an alternative treatment option for patients with duodenal SELs.

Application of novel endoloops to close the defects resulted from endoscopic full-thickness resection with single-channel gastroscope: a multicenter study.

The key step of the endoscopic full-thickness resection (EFTR) procedure is the successful closure of any gastric wall defect which ultimately avoids surgical intervention. This report presents a new method of closing large gastric defects left after EFTR, using metallic clips and novel endoloops by means of single-channel endoscope. We retrospectively analyzed 68 patients who were treated for gastric fundus gastrointestinal stromal tumors originating from the muscularis propria layer at four institutes between April 2014 and February 2015 and consequently underwent EFTR. The large gastric post-EFTR defects were completely closed with metallic clips and novel endoloops using single-channel endoscope, and all the patients were discharged with subsequent endoscopic and clinical follow-up. Patient characteristics, tumor size, en bloc resection rate, closure operation time, and postoperative adverse events were evaluated. EFTR was successfully performed on 68 patients [41 male (60%), 27 female (40%); median age 61years, range 38-73], and the en bloc resection rate was 100%. Complete closure of all the gastric post-EFTR defects was achieved (success rate 100%). The mean closure operation time was 13min (range 9-21min). The mean maximum size of the lesions was 2.6cm (range 2.0-3.5cm). One Mallory-Weiss syndrome and one delayed bleeding were resolved with nonsurgical treatment. The wounds were healed in all cases 1month after the procedure. The use of metallic clips and novel endoloops with single-channel endoscope is a relatively safe, easy, and feasible method for repairing large gastric post-EFTR defects.

RM-066 Histological diagnosis of gastric submucosal tumors after endoscopic submucosal dissection

Introduction: Gastric submucosal tumors (SMTs) such as gastrointestinal stromal tumor (GIST), leiomyoma, leiomyosarcoma, schwannoma, glomus tumor and non-neoplastic lesions such as inflammatory fibroid polyp, heterotopic pancreas and more are frequently identified during routine upper endoscopies. Endoscopic ultrasonography (EUS) is one of the most useful modalities for diagnosing gastric SMTs. However, it is usually not possible to differentiate GIST from benign conditions such as leiomyoma or schwannoma by EUS, especially when the tumor originated from the muscularis propria layer. There are several similar methods for the histological diagnosis of SMTs: mucosal cutting biopsy (MCB), a mucosal incision-assisted biopsy technique, and an “unroofing” biopsy based on endoscopic mucosal resection (EMR). Endoscopic submucosal dissection (ESD) is an advanced endoscopic therapy for SMTs and ESD has rapidly become widely used. Histological diagnosis of the removed tumor is important for the further tactics and prognosis. Methods: We undertook a retrospective review of the 21 patients with gastric SMTs who underwent ESD in our hospital “Oberig clinic” (Kyiv, Ukraine) between January 2009 and December 2015. All patients underwent EUS before the procedure (Olympus EUS EXERA EU-M60, UM DP20-25R). Written informed consent was obtained from all patients. ESD were performed by one experienced endoscopist. (Olympus Exera II, GIF Q-160Z; Olympus Exera III, GIF HQ-190). Results: The patients included 8 men and 13 women with a median age of 57 years (range: 33–67 years). On EUS, 17 tumors (81%) were located in the submucosal layer and 4 (19%) in the muscularis propria layer. Median tumor size was 10 mm (range: 4–35 mm). The tumor sizes were ≤ 20 mm in 17 lesions (86%) and > 20 mm in 4 (14%). Paraffin-embedded resected specimens were sectioned and stained with hematoxylin and eosin. If needed, additional immunohistochemical staining for c-kit (CD117), DOG-1, CD34, desmin, smooth muscle antigen (SMA), or S-100 protein was performed to differentiate tumors of mesenchymal origin. Mesenchymal lesions that stained positive for SMA and desmin were diagnosed as leiomyomas. Lesions that stained positive for c-kit or DOG-1 and CD34 were diagnosed as GISTs. Lesions that stained positive for S-100, chromogranin A, neuron-specific enolase were diagnosed as neuroendocrine tumors. The malignant potential of GISTs was categorized based on tumor size and mitotic counts with Phospho-Histone H3 (mitotic marker), and malignant potential of neuroendocrine tumors was determined with Ki-67. The histological diagnoses were neuroendocrine tumor (n = 7), GIST (n = 5), leiomyoma (n = 4), inflammatory fibrinoid polyp (n = 2), glomus tumor (n = 1), calcifying fibrous tumour (n = 1), aberrant pancreas (n = 1). Conclusion: The final histopathological diagnosis for most gastric SMTs tumors is only possible after the immunohistochemical study. The ESD is an effective, safe, and feasible treatment for gastric SMTs, which can resect the whole lesion and provide pathological information.

Mo1032 A Combination Method of Submucosal Tunneling Endoscopic Resection and Endoscopic Full-thickness Resection for the Treatment of Large Upper Gastrointestinal Submucosal Tumors Originating from the Muscularis Propria Layer

Mo1032 A Combination Method of Submucosal Tunneling Endoscopic Resection and Endoscopic Full-thickness Resection for the Treatment of Large Upper Gastrointestinal Submucosal Tumors Originating from the Muscularis Propria Layer

1040 Novel Forcep Strip Method for Gastric Submucosal Tumors Originating From Muscularis Propria Layer

Resection of submucosal tumors by means of endoscopy has been reported using a variety of techniques. However, lesions originating from the muscularis propria layer are unlikely to be resected completely and safely. Here, we report the first series describing the new technique of endoscopic resection for submucosal tumors of the stomach using the simple and safe forcep strip technique.

Submucosal tunneling endoscopic resection for tumors of the esophagogastric junction

Background: For submucosal tumors (SMTs) originating from the muscularis propria (MP) layer of the esophagogastric junction (EGJ), submucosal tunneling endoscopic resection (STER) is now widely used, and it shows promise in overcoming the limitations of endoscopic submucosal dissection. Aims: This study aimed to evaluate the efficacy and safety of the STER technique for treating SMTs of the EGJ originating from the MP layer. Material and methods: From October 2011 to February 2014, 20 patients were enrolled for STER surgery. Results: The patients were categorized into three groups according to the tumor location. The esophagocardiac group had a lower complication rate (0/7) compared with the cardiac group (3/6) and the gastrocardiac group (3/7). The mean operation time in the esophagocardiac (83 ± 24 min) and cardiac (83 ± 55 min) groups was significantly shorter than that of the gastrocardiac group (145 ± 44 min) (P < 0.05). The en bloc resection rate was 100%, with no severe complications and no recurrence during the follow-up period. Conclusions: The STER technique appears to be a feasible and safe minimally invasive approach for SMTs originating from the MP layer of the EGJ, with satisfying en bloc resection, a short operation time, and low rates of severe complications.

Endoscopic submucosal dissection of gastric subepithelial tumors: a systematic review and meta-analysis

Background/Aims:To evaluate the therapeutic outcomes of the endoscopic submucosal dissection (ESD) technique for the treatment of gastric subepithelial tumors (SETs).Methods:A systematic literature review was conducted using the core databases. Data on the complete resection rates and the procedure-related perforation rates were extracted and analyzed. A random effects model was then applied for this meta-analysis.Results:In all, 288 patients with 290 SETs were enrolled from nine studies (44 SETs originated from the submucosal layer; 246 SETs originated from the muscularis propria layer). The mean diameter of the lesions ranged from 17.99 to 38 mm. Overall, the pooled complete resection rate was estimated to be 86.2% (95% confidence interval [CI], 78.9 to 91.3). If the analysis was limited to the lesions that originated from the submucosal layer, the pooled complete resection rate was 91.4% (95% CI, 77.9 to 97). If the analysis was limited to the lesions that originated from the muscularis propria, the pooled complete resection rate was 84.4% (95% CI, 78.7 to 88.8). The pooled procedure-related gastric perforation rate was 13% (95% CI, 9.4 to 17.6). Sensitivity analyses showed consistent results. Finally, publication bias was not detected.Conclusions:ESD, including endoscopic muscularis dissection, is a technically feasible procedure for the treatment of SETs. However, selection bias is suspected from the enrolled studies. For the development of a proper indication of ESD for SETs, further studies are needed.

Safety of Endoscopic Resection for Upper Gastrointestinal Subepithelial Tumors Originating from the Muscularis Propria Layer: An Analysis of 733 Tumors

Although endoscopic resection is an accepted technique for upper gastrointestinal subepithelial tumors (SETs) originating from the muscularis propria (MP) layer, published data regarding its complications are highly variable and limited to small data series. This study aimed to analyze the safety of endoscopic resection in a large case series. A total of 726 consecutive patients with 733 upper gastrointestinal SETs originating from the MP layer underwent endoscopic resection from June 2005 to December 2014. The complete resection rate, perioperative perforation rate, and perioperative bleeding rate were the main outcome measurements. The complete resection rate was 97.1%. Ninety-four patients had complications (12.9%), including 88 with perioperative perforations (12.1%), 13 with perioperative bleeding (1.8%), 5 with localized peritonitis (0.7%), and one with delayed bleeding (0.1%). Eleven patients required surgery; the others were treated endoscopically. Risk factors for incomplete resection were extensive connection of the tumor to the MP layer (P=0.007) and extraluminal growth (P=0.048). Risk factors for perioperative perforation were larger tumor size (≤2.0 cm vs. 2.1-3.0 cm vs. >3.0 cm, P=0.021), extraluminal growth (P=0.046), and extensive connection (P<0.001). A risk factor for perioperative bleeding was larger tumor size (P=0.045). No residual or recurrent lesions were detected during the follow-up period (median: 28 months). Endoscopic resection is an effective and reasonably safe therapeutic method for treating/removing upper gastrointestinal SETs originating from the MP layer when managed by an experienced endoscopic team.

Intrinsic Gastrointestinal Macrophages: Their Phenotype and Role in Gastrointestinal Motility.

There is an increasing awareness of the role of macrophages in the regulation and maintenance of gastrointestinal function in health and disease. This work has proceeded in the context of an increased understanding of the complex phenotypic variation in macrophages throughout the body and has shown previously unidentified roles for macrophages in diseases such as gastroparesis, postoperative ileus, and inflammatory bowel disease. Opportunities for exploiting the phenotypic modulation of tissue resident macrophages have been identified as possible therapies for some of these diseases. In addition, macrophages are an established component of the innate immune system and can respond to variations and changes in the intestinal microbiome and potentially mediate part of the impact of the microbiota on intestinal health. We reviewed the latest work on novel concepts in defining macrophage phenotype, discuss possible mechanisms of action for tissue-resident macrophages in the gut, address the significance of microbiome effects on macrophage phenotype, and review the known and possible roles of macrophages in motility disorders of the gastrointestinal tract.

A Case Report of Mimicking Sub mucosal Tumor on Esophageal Tuberculosis

Primary esophageal tuberculosis (TB) mimicking submucosal tumors is an extremely rare disease that is difficult to distinguish from benign and malignant tumors. Most esophageal TB cases along with ulcer were diagnosed via routine upper gastrointestinal endoscopy. With the development of new technologies and methods, new progress has emerged in the diagnosis and treatment of esophageal TB. The submucosal tunneling endoscopic resection (STER) solutions are a minimally invasive procedure. The STER technique has been used instead of thoracotomy for diagnosis and treatment esophageal submucosal tumors including esophageal tuberculosis, which has less trauma, shorter hospital stay, less cost and lower complication. Here, we present a case of primary esophageal tuberculosis with non-progressive dysphagia for 4 months in a 41-year-old female. The submucosal tumor originated from the muscularis propria layer of middle piece esophagus wall was firstly diagnosed with upper gastrointestinal endoscope and endoscopic ultrasound examination. We confirmed that the submucosal tumor reveal features suggestive of tuberculosis based on histopathology via STER.

Intestinal Leiomyositis: A Cause of Chronic Intestinal Pseudo-Obstruction in 6 Dogs.

BackgroundIntestinal leiomyositis is a suspected autoimmune disorder affecting the muscularis propria layer of the gastrointestinal tract and is a cause of chronic intestinal pseudo‐obstruction in humans and animals.ObjectiveTo characterize the clinical presentation, histopathologic features, and outcome of dogs with intestinal leiomyositis in an effort to optimize treatment and prognosis.AnimalsSix client‐owned dogs.MethodsRetrospective case series. Medical records were reviewed to describe signalment, clinicopathologic and imaging findings, histopathologic diagnoses, treatment, and outcome. All biopsy specimens were reviewed by a board‐certified pathologist.ResultsMedian age of dogs was 5.4 years (range, 15 months–9 years). Consistent clinical signs included vomiting (6/6), regurgitation (2/6), and small bowel diarrhea (3/6). Median duration of clinical signs before presentation was 13 days (range, 5–150 days). Diagnostic imaging showed marked gastric distension with dilated small intestines in 4/6 dogs. Full‐thickness intestinal biopsies were obtained in all dogs by laparotomy. Histopathology of the stomach and intestines disclosed mononuclear inflammation, myofiber degeneration and necrosis, and fibrosis centered within the region of myofiber loss in the intestinal muscularis propria. All dogs received various combinations of immunomodulatory and prokinetic treatment, antimicrobial agents, antiemetics, and IV fluids, but none of the dogs showed a clinically relevant improvement with treatment. Median survival was 19 days after diagnosis (range, 3–270 days).Conclusions and Clinical ImportanceIntestinal leiomyositis is a cause of intestinal pseudo‐obstruction and must be diagnosed by full‐thickness intestinal biopsy. This disease should be considered in dogs with acute and chronic vomiting, regurgitation, and small bowel diarrhea.

Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors.

Submucosal tunneling endoscopic resection (STER) has become a potential option for the endoscopic treatment of a selected group of patients with submucosal tumors (SMTs) originating from the muscularis propria layer in the upper gastrointestinal tract. The aim of this retrospective study was to analyze the incidence and management of STER-related complications. From January 2011 to August 2013, 290 patients with upper gastrointestinal SMTs treated by STER were included in the study. Clinicopathological characteristics and complication data were collected and analyzed retrospectively. Mucosal injury occurred in three cases (1.0 %) and major bleeding occurred in five cases (1.7 %). The gas-related complications were very common; however, only nine cases of major pneumothorax (> 30 % lung collapse) needed therapeutic intervention (3.1 %). Thoracic effusion occurred in 49 patients, 11 of whom had low grade fever or segmental atelectasis that required thoracentesis and drainage (3.8 %). Thus, although the overall incidence of complications was 23.4 % (68/290), only 10.0 % of procedures (29/290) required intervention for complications. Based on the statistical analysis, irregular shape, tumor in the deep muscularis propria layer, long procedure time, and air insufflation were risk factors of STER-related major complications. Although the incidence of STER-related complications was relatively high, most of these complications were minor and did not require therapeutic intervention. STER is a safe technique for the treatment of upper gastrointestinal SMTs.

Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer.

Submucosal tunneling endoscopic resection (STER) has been proved to be safe and effective for removal of esophageal leiomyoma originating from the muscularis propria (MP) layer. However, there are still technical challenges for tumors ≥35mm due to the limited space of the submucosal tunnel. The aim of the study was to estimate the safety and efficacy of STER for large esophageal leiomyoma originating from the MP layer as well as compare its efficacy with video-assisted thoracoscopic surgery (VATS), which is a standard procedure for treating esophageal leiomyoma. We retrospectively collected the clinical data of the patients with esophageal leiomyoma of 35-55mm who underwent STER or VATS at our hospital between January 2010 and December 2014. Epidemiological data (gender, age), tumor location, tumor size, procedure-related parameters, complications, length of stay and cost were compared between STER and VATS. A total of 31 patients were enrolled, and 18 patients underwent STER and the other 13 received VATS. There was no significant difference between the two groups in gender, age, tumor location, tumor size, complications and rate of en bloc resection (P>0.05). However, patients in the STER groups had a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost (P<0.05). No recurrence was noted in the STER and VATS groups during a mean follow-up of 10.9 and 30.8months, respectively. The treatment efficacy was comparable between the STER and VATS for esophageal leiomyoma of 35-55mm. However, STER is superior to VATS in a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost.

Endoscopic submucosal dissection for the treatment oflarge gastric submucosal tumors originating from themuscularis propria layer: a single center study.

This retrospective study was designed to evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for the resection of gastric submucosal tumors (SMTs) originating from the muscularis propria (MP) layer at our institution. From January 2010 to January 2014, a total of 49 patients underwent ESD for the resection of MP-originating gastric SMTs. The characteristics of the 49patients, clinical efficacy, safety of ESD, and post-ESD pathological diagnoses were evaluated retrospectively. ESD was successfully performed in 48 cases, and one case was converted to surgery. Pathological diagnosis included 43 gastrointestinal stromal tumors, 5 leiomyomas, and 1 schwannoma. During the procedure, 9 patients developed perforation. These patients recovered after conservative treatment. No residual or recurrent tumors were detected during the follow-up period. ESD seems to be a feasible, safe, effective and minimally invasive procedure, even for the resection of large gastric tumors originating from the MP. However, more studies should be carried out in the future.