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

Abstract

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.

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%.…”

Gastroduodenal Intussusception with a Gastric Gastrointestinal Stromal Tumor Treated by Endoscopic Submucosal Dissection

“…We performed endoscopic resection as opposed to surgical resection to remove the tumor, due to the patient’s age (95 years). Several authors have described the usefulness of ESD for small and asymptomatic gastric submucosal tumors (16,17). It was recently reported that endoscopic resection of subepithelial tumors of the stomach has a high success rate with few adverse events (18).…”

Endoscopic Submucosal Dissection Outcomes for Gastroesophageal Tumors in Low Volume Units: A Multicenter Survey

“…An initial study by Li et al on 29 neuroendocrine tumors showed that 28 lesions (96.6%) in the upper GI tract could be completely resected, with only 1 case of delayed bleeding, 0 perforations, and 1 recurrence [9]. Several other case series have recently reported successful ESD for various gastric submucosal tumors such as ectopic pancreas, ectopic spleen, leiomyoma, and gastrointestinal stromal tumor (GIST) [23, 24]. In another case series from France, the authors reported successful resection of 33 submucosal lesions in the stomach for lesions <20 mm, with the majority of lesions being resected by ESD [25].…”