Endoscopic Management of Upper Gastrointestinal Submucosal Tumors Arising from Muscularis Propria

Abstract

Small (<2 cm) or incidentally found gastrointestinal submucosal tumors pose challenges to gastroenterologists due to the potential malignancy of tumors and current suboptimal diagnostic methods. On the basis of the development of endoscopic submucosal dissection, recent technical advances, including endoscopic submucosal excavation, submucosal tunneling and endoscopic resection, and endoscopic full-thickness resection, have been able to resect submucosal tumors in the muscularis propria. These techniques provide definitive histologic diagnosis as well as a minimally invasive therapeutic approach to such tumors. Current studies, despite with promising results, are limited to small, retrospective studies, focusing on introducing new methods and varied in technical details. This review provides a thorough discussion of technical details of each endoscopic method, and compares different methods in terms of tumor sites, to ensure safety and optimize treatment outcomes.

Submucosal tunneling endoscopic resection of large submucosal tumors originating from the muscularis propria layer in the esophagus and gastric cardia

“…Presently, some controversies still exist in the resection of the esophagus and cardia tumors located in the MP layer [7][8][9][10]. STER is a new endoscopic treatment that uses the submucosal space between the mucosal and muscular layers [3].…”

Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review

“…When sGST is not close to the cardia, it is difficult to establish a tunnel, and therefore the STER technique is not applicable. STER has many advantages, including maintenance of mucosal integrity, small wounds, fast healing, clear operating vision, and reduced risk of pleural and abdominal infections[ 58 ]. A clinical study involving 290 cases showed that the overall incidence of complications was high [23.4% (68/290)], but only a small percentage thereof (10.0%) required therapeutic intervention[ 59 ].…”

The experience of endoscopic resection of benign tumors of the esophagus

“…Кроме того, из-за близости к верхнему пищеводному сфинктеру, который обуславливает узость верхней трети пищевода, маневрирование эндоскопом при создании тоннеля и энуклеации опухоли затруднено. Нами [16] описаны также ситуации возникновения подкожной эмфиземы шеи при использовании тоннельной эндоскопической методики для удаления новообразований верхней трети пищевода. По литературным данным [17], создание тоннеля для ПТЭР наиболее удобно в средней, нижней трети пищевода и кардии, что соответствует наиболее частой локализации лейомиом -средняя треть (43 %) и нижняя треть пищевода (53 %) [18].…”