Feasibility and Safety of Mark-Guided Submucosal Tunneling Endoscopic Resection for Treatment of Esophageal Submucosal Tumors Originating from the Muscularis Propria: A Single-Center Retrospective Study

Abstract

Background. Submucosal tunneling endoscopic resection (STER) has effectively removed esophageal submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. However, clinical failure and adverse events of STER remain concerned. In this study, we described a mark-guided STER (markings before creating entry point) and evaluated its feasibility and safety for esophageal SMTs originating from MP. Methods. Patients receiving the mark-guided STER from October 2017 to July 2020 were included and followed up (ranged from 3 to 30 months). The primary outcomes included complete resection, en bloc resection, and R0 resection rates. The secondary outcomes included procedure duration, main complication, and residual lesions. Results. A total of 242 patients with 242 SMTs (median diameter of 22 mm, ranging from 7 mm to 40 mm) received the mark-guided STER. The median procedure duration was 55 min (ranging from 35 min to 115 min). The complete resection, en bloc resection, and R0 resection rates were 100%, 98.3%, and 97.5%, respectively. The adverse event rate was 4.5%. However, there was no severe complication. No residual SMTs were detected during the follow-up period. Logistic regression demonstrated that the SMT size and procedure duration were independent factors associated with en bloc resection ( P = 0.02 and P = 0.04 , respectively). Moreover, logistic regression demonstrated that the SMT size was an independent risk factor for main complications ( P = 0.02 ). Conclusion. Mark-guided STER was feasible and safe to remove esophageal SMTs ≦40 mm. However, it is necessary to further verify the feasibility and safety for the esophageal SMTs >40 mm.

Application of a hybrid approach to the removal of large esophageal schwannoma

“…Стоит отметить, что при полнослойном дефекте стенки пищевода возможность герметичного закрытия доступа в тоннель при помощи эндоскопических клипс позволяет минимизировать риски послеоперационных осложнений, что является основным преимуществом данной методики. Как правило, риск развития послеоперационных осложнений имеет прямую зависимость от размера и конфигурации новообразования [24].…”

Clinical study of submucosal tunneling endoscopic resection and endoscopic submucosal dissection in the treatment of submucosal tumor originating from the muscularis propria layer of the esophagus

“…This avoids any irritation from gastric reflux, thus reducing the incidence of delayed bleeding. [ 3 , 28 ] In a randomized controlled trial, it was noted that the lack of a plasma membrane layer can easily cause perforation after the resection of deeper intrinsic esophageal myxomatous tumors; furthermore, owing to a narrower esophageal lumen and greater wall tension in such cases, titanium clips cannot completely and effectively close the perforation, making the individuals prone to developing postoperative complications and even requiring surgical intervention. [ 29 ] Studies have shown that the application of some new methods and materials, for example, a newly invented injectable “thermogel as a novel submucosal injectable substance can reduce the incidence of complications in ESD.…”

“…[ 8 , 9 ] Anxiety and frustration, lack of knowledge, and financial challenges are major barriers that keep patients from availing cancer prevention treatments, thus leading to rapid progression of the disease. [ 3 ] Therefore, endoscopic techniques are currently preferred over surgical resection of submucosal esophageal tumors. This study investigates two endoscopic techniques, one of which is endoscopic submucosal dissection (ESD), which is a commonly used method for treating SMT.…”

“…ESD allows for direct endoscopic debridement of the tumor and offers a high rate of complete resection and low recurrence rates with low chances of their remaining any residual tumor. [ 3 ] However, tumors originating from the intrinsic MP require total resection, which makes ESD surgery prone to complications, such as perforation. The other approach is submucosal tunneling endoscopic resection (STER), which is a modified endoscopic technique based on ESD and is gradually incorporated for the treatment of esophageal SMT.…”

“…With the widespread use of ultrasound, gastrointestinal endoscopy techniques, and instruments, the SMT detection rate has been greatly improved. Although most tumors of the intrinsic muscular layer (MP) of the esophagus are benign, the biological behavior is difficult to determine for some of these lesions, and they may have some malignant potential, [1][2][3][4] particularly if they originate from the intrinsic MP or are large-sized SMTs, which are attributes that strongly suggest a malignant potential. [5,6] Infiltration can be definitively ruled out only after endoscopic resection.…”