Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer

Lee, I.-L.; Lin, Paul; Tung, Shui‐Yi; Shen, C.-H.; Wei, Kuo-Ling; Wu, Chi-Huan

doi:10.1055/s-2006-944814

Cited by 167 publications

(146 citation statements)

References 12 publications

(16 reference statements)

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“…FNA in our series was able to confirm GIST only in 2 of 8 cases without the evaluation of the mitotic index. The high success rate (90 % in our series) achieved with ESD and the absence of relevant complications suggest this procedure as a diagnostic and in some case therapeutic option in the resection of SMTs [15][16][17][18][19]. The main limitation of this study was that patients were assigned to ESD based solely on the patient's attitude.…”

Section: Discussionmentioning

confidence: 83%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

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Background A submucosal tumor (SMT) of the stomach, which is an occasional finding during routine upper gastrointestinal endoscopy, may pose diagnostic and therapeutic challenges. Methods To assess whether endoscopic submucosal dissection (ESD) is a feasible approach to definitively cure SMTs, the authors performed a retrospective cohort study with two endoscopic italian centers.Results The study consisted of 20 patients with SMTs who underwent ESD. The patients underwent ESD and were followed up by endoscopy. We analyzed complete resection rate, frequency of complications, and survival. The overall rate of R0 resection was 90 % (18/20), with two endoscopic failures, one for a submucosal tumor and one for a neoplasm deeply infiltrating the proper muscle layer. The median procedure time was 119.1 min (range 40-240 min). The median size of the resected specimens was 29 mm (range 15-60 mm). Perforation occurred in 3 patients; all were treated conservatively. There were no cases of severe bleeding. Based on histopathological findings, 6 cases of ectopic pancreas, 1 of ectopic spleen, 3 of leiomyoma, and 10 of gastrointestinal stromal tumor (GIST) were diagnosed. Complete resection was obtained in all GIST cases. Among the 10 GIST cases treated by ESD, no death occurred: the 5-year disease-specific survival rate was 100 %. Conclusions The high success rate of 90 % and the low incidence of complications should indicate ESD is the correct diagnostic and definitive treatment in selected patients.

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Section: Discussionmentioning

confidence: 83%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

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“…Endoscopic submucosal dissection (ESD) is an effective technique for completely resecting SMTs originating in the submucosal layer, and is associated with fewer complications than other treatment methods. However, gastric SMTs originating in the MP layer are located deep within the lesion, and the higher incidence of perforation and bleeding limits the use of ESD to remove them (Park et al, 2004;Lee et al, 2006;Zhou et al, 2011;Bialek et al, 2012;Chun et al, 2013;Hobel et al, 2014;Meng et al, 2015). Laparoscopic-assisted endoscopic full-thickness resection (EFR) is a technique in which an iatrogenic perforation of the gastric wall is created for the purpose of removing a deep gastric lesion for patient treatment or to obtain a precise pathological diagnosis (Jeon et al, 2010;Ye et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

Wang

Jin

et al. 2017

J. Zhejiang Univ. Sci. B

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Minimally invasive endoscopic resection has been rapidly adopted as a new technique for treating patients with gastric submucosal tumors (SMTs) originating in the muscularis propria (MP) layer. This study was conducted to evaluate the information obtained from endoscopic ultrasonography (EUS) to determine the appropriate endoscopic dissection method for treating SMTs originating in the MP layer. Between February 2014 and May 2016, a total of 50 patients with gastric SMTs originating in the MP layer were enrolled in this study. The clinical features of the patients and their endoscopic, EUS, and histopathologic findings, as well as their postoperative follow-up data, were analyzed in this retrospective study. The mean age of the patients was (55.0±10.2) years, and the male/female ratio was 17:33. Endoscopic submucosal dissection (ESD) was performed on 43 patients and an endoscopic full-thickness resection (EFR) was performed on seven patients. The most frequent location for an SMT was in the upper body region of the stomach (n=16), and the most common pathological diagnosis was a gastrointestinal stromal tumor (GIST) (n=32). The overall rates for complete resection were 95.3% (41/43) and 100.0% (7/7) when the SMTs were treated by ESD and EFR, respectively. The presence of a complete tumor capsule was significantly associated with a complete resection (P=0.001). Of the cases treated by ESD, nine patients developed perforation, one of whom required laparoscopic surgery. The remaining patients were closed with clips or purse-string sutures. The presence of an MP2-type tumor (P=0.018) and a wide connection with the MP layer (P=0.044) were significantly associated with perforation. A preoperative evaluation of the integrity and the location of a tumor capsule and the length of the tumor connection with the MP layer by EUS can improve the complete resection rate and reduce the occurrence of intraoperative complications. Tumors with a complete capsule originating from the superficial MP layer or with a narrow connection with the MP layer are appropriate candidates for treatment by ESD.

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“…There is also a limit to the en-bloc resection that may be performed without damaging the tumor in a narrow operative field accessible through a small opening. Three case series with similar inclusion criteria and methods reported comparable rates of successful en-bloc resection for SETs originating in the MP layer (61-68%) and severe complications due to perforation (5.4, 0 and 12%, respectively) (8,21,22). Therefore, minimally invasive local resection techniques, such as NOTES, appear to be suitable for the treatment of SETs originating from the MP layer (2,3).…”

Section: Discussionmentioning

confidence: 96%

Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa

Kobara

Mori

Rafiq

et al. 2013

Molecular and Clinical Oncology

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Abstract. Endoscopic submucosal dissection (ESD) for upper gastrointestinal (GI) subepithelial tumors (SETs) originating in the muscularis propria (MP) layer is associated with numerous issues regarding secure closure and measures against accidental perforation. However, symptomatic benign GI SETs or carcinoid tumors originating in the submucosa (SM) may be safely resected en-bloc using ESD. In this study, the feasibility and safety of ESD as a novel method for endoscopic resection for such GI SETs revealed on endoscopic ultrasonography (EUS) was investigated. A total of 12 consecutive cases of patients with symptomatic benign SETs (n=3; 1 esophageal hemangioma and 2 gastric lipomas) or small carcinoid tumors (n=9; <10 mm, with an extremely low risk of metastasis) originating in the SM as determined on EUS, between March, 2009 and April, 2013, were retrospectively reviewed. The lesions were resected by ESD after confirming that the tumors originated from the SM. The complication rate following en-bloc resection was also determined. En-bloc resection was achieved in all 12 cases, the mean procedure time was 45 min (range, 20-120 min) and no complications occurred intra-or postoperatively. There was no tumor recurrence or disease-related mortality reported during the follow-up period (median follow-up time, 13.4 months). Histopathological curative resection was achieved with ESD without complications in all 9 cases with carcinoid tumors. Therefore, if EUS reveals a SET originating in the SM without infiltration of the MP and resection is indicated due to the presence of abdominal symptoms, ESD may be a feasible option for diagnostic treatment with minimal invasiveness. However, larger-scale prospective studies are required to establish the feasibility and safety of this procedure.

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Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer

Abstract: ESD can be used for the resection of intraluminal gastric subepithelial tumors and could replace treatment by surgical resection in some cases. EMR-c is an alternative method that can be used to obtain sufficient tumor tissue for histological diagnosis if complete resection by ESD fails.

Cited by 167 publications

References 12 publications

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa

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