Endoscopic submucosal dissection for gastric adenomyoma

Abstract

Gastric adenomyoma (GA) is a kind of rare gastric submucosal eminence lesions. As the malignant transformation cannot be ruled out, surgery and laparoscopic resection are usually considered. The aim of this study is to evaluate the therapeutic effect and safety of endoscopic submucosal dissection (ESD) for GA.All of the patients with gastric submucosal eminence lesions who underwent ESD from June 2008 to June 2015 in General Hospital, Tianjin Medical University, China, were identified, and patients with GA, which was confirmed by pathological evaluation, were enrolled for further analysis.Among the 571 patients who received ESD, 15 cases with uncertain diagnosis before the procedure were finally confirmed as GA. The mean age of these 15 patients was 46.93 ± 15.56 years (range: 18–73). Most of the lesions were located in antrum (12/15 patients), with 2 in the body of stomach and 1 in cardia, respectively. The mean size of the lesions was 1.47 ± 0.67 cm (range: 0.4–3.0). According to the endoscopic ultrasonography, the lesions of 14 patients originated from submucosa and 1 originated from superficial muscularis, totally with mixed echoes changes. En bloc complete resection was achieved in all of the lesions. No perforation, intraoperative bleeding, delayed bleeding, and mortalities occurred. No recurrence or metastasis was found during 1 to 67 months.ESD appears to be a feasible, safe, and effective treatment for GA with clinical presentation of gastric submucosal eminence lesions.

Polypoid Gastric Adenomyoma: A Rare Cause of Bleeding Treated With Polypectomy

“…Wang et al reported a series of 15 gastric adenomyomas appearing as mucosal eminences, sized 0.4–3 cm, treated endoscopically, of which, 2 were found in the body and 1 presented with melena. 6…”

“…12,17 Recurrence after resection has not been described. 1,3,6 In East Asia, endoscopic submucosal dissection has been used in en bloc resection of gastric submucosal eminence lesions. Wang et al reported a series of 15 gastric adenomyomas appearing as mucosal eminences, sized 0.4-3 cm, treated endoscopically, of which, 2 were found in the body and 1 presented with melena.…”

“…Wang et al reported a series of 15 gastric adenomyomas appearing as mucosal eminences, sized 0.4-3 cm, treated endoscopically, of which, 2 were found in the body and 1 presented with melena. 6 In few cases, endoscopic ultrasound has been used to obtain useful information about the location of the tumor in the stomach wall to guide selection of candidates who can be treated with endoscopic removal vs laparoscopic resection based on the location in the submucosa or muscularis propria, respectively. 18 In our case, owing to the polypoid appearance, endoscopic polypectomy was possible; thus, endoscopic ultrasound was not attempted.…”

“…1 It was first reported by Magnus-Alsleben in 1903, and nearly 67 cases of gastric adenomyomas have been described through 2017. [2][3][4][5][6] There are various theories regarding the etiology of adenomyomas, indicating that gastric adenomyoma may be a form of epithelial hamartoma or heterotopic pancreatic tissue. Although it is considered a benign tumor, a malignant potential has been reported.…”

Gastric Inverted Polyps—Distinctive Subepithelial Lesions of the Stomach

“…However, morphologic overlapping exists between GCP and type 2 GIP: in our study, 2 cases of type 2 GIPs exhibited GCP-like areas, and similar findings have been reported by Yamashita et al 8 and Lee et al 13 We think GCP-like cystic changes might be related to a submucosal localization of GIP with no communication with the overlying mucosa. Gastric adenomyoma, known as an abortive variant or type III heterotopic pancreas, may also be a diagnostic consideration because, by endoscopy, it appears as an SEL with central umbilication, 4,28 similar to some GIPs with a central orifice or depression. However, gastric adenomyomas principally occur in the distal stomach (antrum or pylorus), which are ectopic ductular structures of Brunner-type cuboidal or columnar epithelia encased by smooth muscle; they lack gastric-type glands, which is the key difference from GIPs.…”