Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer

Abstract

Minimally invasive endoscopic resection has become an increasingly popular method for patients with small (less than 3.5 cm in diameter) gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.

A comparison of submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric fundus submucosal tumors

“…Endoscopic resection was also performed for patients who have a strong desire for removal of SMTs < 2 cm, usually due to the stress of repeated endoscopic procedures and the risk of malignancy. It is worth mentioning that periodical surveillance still remains one of the recommended strategies for gastric SMTs < 2 cm.Endoscopic resection has been widely accepted as an alternative method for gastric SMTs originating from the MP layer and endoscopic options include ESD, endoscopic submucosal excavation (ESE), EFTR and STER (3,4). ESD was used to treat gastric SMTs originating from the superficial MP layer.…”

“…ESD was used to treat gastric SMTs originating from the superficial MP layer. However, when the tumor originates from the deep MP layer or has a tight connection with the underlying MP layer or serosal layer, the complete resection rate decreases and the complication rate increases (4,16,17). Although ESE could improve the complete resection rate for gastric SMTs from the deep MP layer, it has some limitations for lesions with a tight connection with the serosal layer or with an extraluminal growth (4,18).…”

“…However, this raises issues with regard to the compliance and stress levels of the patient, cost-effectiveness and the risk associated with repeated endoscopic procedures and a delayed diagnosis of malignancy (1,2). Therefore, it is necessary to remove SMTs and endoscopic resection is an alternative method (3,4). Endoscopic full-thickness resection (EFTR) has proved to be a safe and effective endoscopic method for the treatment of gastric fundus SMTs that originate from the muscularis propria (MP) layer, with a high rate of complete resection (5)(6)(7)(8)(9)(10).…”

Endoscopic excavation technique for gastric gastrointestinal stromal tumor: A case report

“…A UTHORS DECLARE NO conflicts of interest for this article. 1 and it is almost the same procedure as submucosal tunneling endoscopic resection (STER) reported at the same time. 2 The concept of obtaining working space from the creation of a submucosal tunnel in POET is based on the technique of peroral endoscopic myotomy (POEM).…”

“…The number of clinical trials investigating endoscopic resection of SET originating from the muscularis propria layer has increased recently. [1][2][3][4][5] These trials reported that some SET originating from the muscularis propria can be safely resected using EGD without perforations or any other serious complications. However, its effectiveness, safety, and appropriate indication are not entirely known.…”