Efficacy and safety of endoscopic submucosal dissection in treating gastric subepithelial tumors originating in the muscularis propria layer: a single-center study of 144 cases

Abstract

OBJECTIVE. Subepithelial tumors (SETs) in the stomach are usually considered benign. However, some do have potential for malignant transformation, especially when originating in the muscularis propria (MP). Our study aimed to evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for gastric SETs originating in MP. MATERIAL AND METHODS. A total of 145 gastric MP SETs in 144 patients were treated by ESD between September 2008 and December 2012. Characteristics of patients and SETs, therapeutic outcomes, pathologic characteristics, complications and follow-up outcomes were evaluated. RESULTS. Among the 144 patients, 104 were female (72.22%) and 40 were male (27.78%), and the mean age was 55.75 ± 11.29 years (range 18-78 years). The mean size of the tumors determined by endoscopic ultrasound (EUS) was 15.14 ± 9.70 mm (range 3-50 mm). En bloc complete resection was achieved in 134 of 145 tumors, giving a complete resection rate of 92.41%. The final histopathologic diagnoses included 52 leiomyomas, 89 gastrointestinal stromal tumors, 3 neurogenic tumors and 1 lipoma. Perforations occurred in 21 patients (14.48%) and were endoscopically repaired with clips or nylon bands. Intraoperative bleeding occurred in seven patients (4.83%) and was corrected with argon plasma coagulation (APC) or hot biopsy forceps. No local recurrence or distant metastasis was detected during a mean follow-up of 19.14 ± 10.29 months (range 3-51 months). CONCLUSIONS. ESD appears to be an effective and safe treatment for gastric SETs originating in MP.

Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract

“…Thus, we assume that endoscopic approach should be highly selective. To our knowledge, our study contains the largest number of GIST in the UGIT resected by the endoscopic procedure, considering that previous studies only included small number of case series attached to clinical data of gastric SETs resected by ESD, STER or EFTR, [15][16][17][18][19][20][27][28][29][30] and their follow-up duration was relatively short, ranging from 2 to 21 months, 15,17,20,27,28,30,31 or even not presented. 16,18,29 Endoscopically resected cases in our study were followed up for 46 months on average, longer than previous studies, but nevertheless, the recurrence rate was 2.2%.…”

“…This was compatible with previously published data reporting no recurrence during relatively shortterm duration of follow-up. 15,17,20,28,30,31 M A N U S C R I P T…”

Management of early asymptomatic gastrointestinal stromal tumors of the stomach

“…R0 resection of the more common gastric GIST that arise from the muscularis propria cannot be achieved using traditional endoscopic techniques. However, a lot of them can be completely en bloc resected by endoscopic submucosal dissection in expert hands [9] . (Laparoscopic) Surgical resection is the method of choice for larger GIST.…”

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

“…The included studies were published between 2006 and 2013. Seven studies were conducted in Asia [7,20,23-27] (three studies in China [24,25,27], two studies in Japan [7,23], one study in Korea [26], and one study in Taiwan [20]), and two studies were conducted in Europe (one study in Poland [21], and one study in Italy [22]). All of the included studies were written in English.…”