Efficacy and Safety Analysis of Submucosal Tunnel Endoscopic Resection for Submucosal Masses in Esophageal Muscularis Propria

Abstract

Objective. To analyze the efficacy and safety of submucosal tunnel endoscopic resection (STER) for the treatment of submucosal masses in esophageal muscularis propria. Method. A total of 272 patients with submucosal masses in esophageal muscularis propria diagnosed and treated in our hospital from February 2019 to January 2022 were randomly selected for the study and then were randomly divided into the STER group ( n = 136 ) and the endoscopic mucosal dissection (ESD) group ( n = 136 ) according to the random number table method. Patients in the STER and ESD groups were treated with STER and ESD, respectively. The clinical data of patients from the two groups were collected and compared. The clinical effects and the changes of surgery-related indexes of patients after ESD and STER treatment were observed. The safety of ESD and STER was compared. The factors influencing the efficacy of STER treatment for submucosal masses in esophageal muscularis propria were analyzed. Result. There were significant differences between the STER group and the ESD group in terms of tumor size, lesion level, adhesion and surgical approaches ( P < 0.05 ). The effective rates of ESD treatment and STER treatment were 98.53% and 88.97%, respectively. Meanwhile, the effective rates of STER treatment were significantly higher than those in the control group ( P < 0.05 ). In addition, the patients in the STER group had longer operation time, less blood loss, and shorter hospital stay compared with those in the ESD group ( P < 0.05 ). Adverse reactions occurred during ESD treatment and STER treatment included delayed bleeding, adhesion, perforation, and pleural effusion with the total incidence of adverse reactions of 4.41% and 13.97%, respectively. The adverse reactions in STER group were prominently less than these in the ESD group ( P < 0.05 ). Logistic multivariate regression analysis showed that independent risk factors, including tumor size, lesion level, adhesion, and surgical approaches, affected the efficacy of STER in the treatment of submucosal masses in esophageal muscularis propria ( P < 0.05 ). Conclusion. STER is an effective method for the treatment of submucosal masses in esophageal muscularis propria, which can exhibit a good effect with faster postoperative recovery and higher safety, thereby being worthy of clinical application and promotion. Tumor size, lesion level, adhesion, and surgical approaches are all related factors affecting the effect of STER treatment.

Management of delayed bleeding of upper gastrointestinal endoscopic submucosal tunneling procedures: a retrospective single‐center analysis and brief meta‐analysis

“…39 Other risk factors, such as submucosal fibrosis, prior treatment, sigmoid esophagus, antithrombotic therapy, and tumor size, may increase the risk of delayed bleeding after POEM or STER. [40][41][42] Insufficient coagulation of visible vessels influences the likelihood of delayed bleeding. 43 However, this benefit of prophylactic coagulation must be weighed against the increased risk of perforation with increased coagulation exposure.…”

“…There is a large wound surface post‐myotomy after POEM, which is a significant risk factor for delayed bleeding 39 . Other risk factors, such as submucosal fibrosis, prior treatment, sigmoid esophagus, antithrombotic therapy, and tumor size, may increase the risk of delayed bleeding after POEM or STER 40–42 . Insufficient coagulation of visible vessels influences the likelihood of delayed bleeding 43 .…”

Stretching the limits of submucosal tunneling endoscopic resection

“…Leiomyomas are benign lesions requiring resection when they cause obstructive symptoms, with an upper size limit for an endoscopic en bloc resection advised by the European guidelines of 35 mm, below that of the presented case 1 . STER allows the resection of tumors by tunneling the submucosa, minimizing the mucosal defect 2 3 . Thoracoscopy enucleation is a surgical alternative, although no comparative studies are available 4 .…”