Management of gastrointestinal subepithelial tumors with endoscopic resection

Abstract

The diagnosis and management of gastrointestinal subepithelial tumors (GI SETs) have been under debate because of the low biopsy yield rate and risk of surgery. Owing to the advancement in endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER), GI SETs may be resected under acceptable risk, and the nature of GI SETs can be studied. However, the efficacy of endoscopic resection in the diagnosis and management of GI SETs remains unclear. We present our single-hospital experience of resecting GI SETs with ESD and STER to explore the efficacy of this technique and the nature of GI SETs. Thirty-nine patients with GI SETs who underwent ESD and STER were analyzed retrospectively. Patients' clinical data, procedure parameters, pathologic diagnosis, and outcomes were collected and analyzed. Thirty-nine GI SETs were resected, 36 by ESD, and 3 by STER. Thirty-eight (97.4%) tumors were from the submucosal layer and one from the muscular layer. Fifteen, 13, and 11 tumors were located in the esophagus, stomach, and colon, respectively. The mean tumor size was 16.8 ± 1.3 mm. In the esophagus, leiomyomas were the most common diagnosis, followed by the lymphoepithelial cyst, epithelial hyperplasia, focal lymphoid hyperplasia, and dilated submucosal gland. The esophageal tumor from the muscularis propria was GI stromal tumor (GIST). In the stomach, 53.8% of the submucosal tumors were ectopic pancreas, followed by lipoma, calcifying fibrous tumor, GIST, submucosal inflammation, and angiodysplasia with focal ulcers. The submucosal tumors in the colon were diagnosed as neuroendocrine tumors (NETs, n = 5), lipomas (n = 4), leiomyoma (n = 1), and foreign body-related granuloma (n = 1). Seven (17.9%) of all tumors were NETs and GISTs with malignant potential. All cases were resected completely. The overall procedural time was 37.9 ± 4.6 minutes. Severe fibrosis was more likely encountered in the stomach with a rate of 46.1%, with the gastric ectopic pancreas having a 71.4% severe fibrosis rate. Only 13 patients completed follow-up endoscopic ultrasound or endoscopy within 1 year after ESD and STER, and no recurrence was noted. There were no major complications, and none of the patients required admission to the intensive care unit or surgery. Three perforations were encountered during STER, which were smoothly

Exploring the landscape of colorectal endoscopic submucosal dissection in Taiwan: In‐depth investigation of complication risks

“…In a study conducted by Chou et al, the feasibility of utilizing ESD for treating superficial pharyngeal squamous cell carcinoma was demonstrated in 10 patients with 11 lesions. 10 The results revealed an impressive en bloc resection rate of 91% (10/11) and a complete resection rate of 36% (4/11). This study establishes that ESD for superficial pharyngeal cancer is a secure and viable treatment option, offering favorable and promising results in Taiwan.…”

“…Their dedication to research and innovation has played a pivotal role in pushing the boundaries of medical practice and improving patient care in this field. In a study conducted by Chou et al, the feasibility of utilizing ESD for treating superficial pharyngeal squamous cell carcinoma was demonstrated in 10 patients with 11 lesions 10 . The results revealed an impressive en bloc resection rate of 91% (10/11) and a complete resection rate of 36% (4/11).…”

“…Endoscopic management for subepithelial gastrointestinal lesions has demonstrated highly favorable outcomes in Taiwan. 10 The introduction of endoscopic suturing systems has empowered Taiwanese endoscopists to manage large gastric and duodenal gastrointestinal stromal tumors effectively, marking the first case reports of such procedures in Asia. 11,12 Peroral endoscopic myotomy for achalasia, antireflux mucosal intervention for gastroesophageal reflux, and gastric peroral endoscopic myotomy for gastroparesis in Taiwan have yielded exceptionally positive clinical outcomes.…”

“…This study establishes that ESD for superficial pharyngeal cancer is a secure and viable treatment option, offering favorable and promising results in Taiwan. Endoscopic management for subepithelial gastrointestinal lesions has demonstrated highly favorable outcomes in Taiwan 10 . The introduction of endoscopic suturing systems has empowered Taiwanese endoscopists to manage large gastric and duodenal gastrointestinal stromal tumors effectively, marking the first case reports of such procedures in Asia 11,12 .…”