Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer

Shi, Qiang; Zhong, Yun‐Shi; Yao, Ling; Zhou, Ping‐Hong; Xu, Mei‐Dong; Wang, Ping

doi:10.1016/j.gie.2011.07.039

Cited by 103 publications

(50 citation statements)

References 22 publications

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“…Strengths of our study included its relative large size (considering the low incidence of esophageal/cardial SMTs and the study size of other published literatures), relative long period of Follow-up (since 2010), subgroup analysis based on tumor size, and that potential bias was reduced in several ways. Although this was a one-center retrospective study, our therapeutic results were in accordance with the published literatures [4,5,7,8,11,12,17] ); slight difference in complete resection rate, perforation rate, and operation time can be largely explained by limited study size (31 at most [4] ). Time bias did exist as endoscopist had gotten better and better as time went on.…”

Section: Discussionsupporting

confidence: 89%

Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

et al. 2014

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Section: Discussionsupporting

confidence: 89%

Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

et al. 2014

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“…Endoscopic resection is a first-line treatment for SMTs ≤50 mm in diameter (1,2). Alternative methods include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection, but these may be associated with unsatisfactory outcomes due to incomplete resection and/or the risk of perforation during the procedure (3)(4)(5). Submucosal tunneling endoscopic resection (STER) has emerged as a novel technique for treating upper gastrointestinal SMTs and has yielded promising results (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer (Review)

2017

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Abstract.Gastrointestinal submucosal tumors (SMTs) have been increasingly identified via the use of endoscopic ultrasonography, and removal is often recommended for SMTs that are >2 cm in diameter or symptomatic. Submucosal tunneling endoscopic resection (STER), also known as submucosal endoscopic tumor resection, endoscopic submucosal tunnel dissection or tunneling endoscopic muscularis dissection, is a novel endoscopic technique for treating gastrointestinal SMTs originating from the muscularis propria layer, and has been demonstrated to be effective in the removal of SMTs with a decreased rate of recurrence by clinical studies. STER may be performed for patients with esophageal or cardia SMTs, and its application has expanded beyond these types of SMTs due to modifications to the technique. The present study reviewed the applications, procedure, efficacy and complications associated with STER. IntroductionFollowing the identification of a gastrointestinal submucosal tumor (SMT), periodic surveillance using endoscopy and endoscopic ultrasonography (EUS) remains a major strategy, but the use of this strategy is associated with multiple concerns, including patient compliance and stress, cost-effectiveness, and the risks associated with repeated endoscopic procedures and delayed diagnosis of malignancy (1,2). Furthermore, certain tumors exhibit malignant potential, particularly those that originate from the muscularis propria (MP) layer or are large in diameter (1). Therefore, removing these SMTs is crucial. Current methods to remove SMTs include surgery and endoscopic resection, compared with the latter, surgical approaches are more invasive and associated with increased costs and a longer hospital stay. Endoscopic resection is a first-line treatment for SMTs ≤50 mm in diameter (1,2). Alternative methods include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection, but these may be associated with unsatisfactory outcomes due to incomplete resection and/or the risk of perforation during the procedure (3-5). Submucosal tunneling endoscopic resection (STER) has emerged as a novel technique for treating upper gastrointestinal SMTs and has yielded promising results (6-17). STER possesses multiple advantages over other endoscopic methods, including the maintenance of mucosal integrity, the facilitation of an increased rate of healing and a decreased risk of pleural/abdominal infection. In addition, the submucosal tunnel helps to maintain a clear visual field, which facilitates an improved response to intraoperative bleeding. The present study summarized the current status of STER, including its applications, procedure, efficacy and complications. Preoperative assessmentPrior to performing STER, the presence, originating layer, size, and the presence or absence of malignancy-associated

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“…However, endoscopic surgery does have some drawbacks, such as the risks of incomplete resection, perforation, and bleeding. Several feasibility studies have shown that when used to treat SMTs originating in the MP layer, standard ESD achieves a complete resection in 64% to 75% of cases (Park et al, 2004;Lee et al, 2006;Bialek et al, 2012;Chun et al, 2013;Hobel et al, 2014;Meng et al, 2015) and produces perforation in 0% to 20% of cases (Probst et al, 2009;Jeon et al, 2010;Shi et al, 2011;Zhang et al, 2011;Bialek et al, 2012;Hobel et al, 2014). Therefore, when choosing an endoscopic procedure, a preoperative evaluation is important for avoiding both unnecessary surgery and the subsequent procedures.…”

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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Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer

Cited by 103 publications

References 22 publications

Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer (Review)

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

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