Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma

Wang, Lei; Ren, Wei; Zhang, Zhimei; Yu, Jing; Li, Yihui; Song, Yuankun

doi:10.1007/s00464-013-3035-z

Cited by 58 publications

(28 citation statements)

References 27 publications

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“…Thus, submucosal injection of different solutions (such as glicerol or hyaluronic acid) a cushion beneath the lesion is created, separating the mucosa from the muscularis propia and enabling the tumor excision through a endoscopic submucosal dissection (ESD) (16,32), which safely allows enucleation of lesions that arise in the muscularis mucosae and the muscularis propia layer up to 3 cm. Endoscopic submucosal tunnel dissection (ESTD) has also been recently described, showing similar results and a lower risk of complications (27,28). We do not have enough experience in this kind of procedures, but we think they could be an available management alternative for experienced groups and small tumors, according to the published results (Fig.…”

Section: Discussionmentioning

confidence: 93%

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

et al. 2015

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Introduction: Leiomyomas are the most common benign tumors of the esophagus. Although classically surgical enucleation through thoracotomy or laparotomy has been widely accepted as treatment of choice, development of endoscopic and minimally invasive procedures has completely changed the surgical management of these tumors. Material and methods:We performed a retrospective review of all esophageal leiomyoma operated at Hospital Universitario Ramón y Cajal (Madrid, Spain) between January 1986 and December 2014, analyzing patients' demographic data, symptomatology, tumor size and location, diagnostic tests, surgical data, complications and postoperative stay.Results: Thirteen patients were found within that period, 8 men and 5 women, with a mean age of 53.62 years (range 35-70 years). Surgical enucleation was achieved in all patients. In 8 cases (61.54%) a thoracic approach was performed (4 thoracotomies and 4 thoracoscopies), and in 5 cases (38.56%) an abdominal approach was performed (3 laparotomies and 2 laparoscopies); enucleation was carried out through a minimally invasive approach in 6 patients (46.15%). There were no cases of endoscopic resection alone. Surgery mean length was 174.38 minutes (range 70-270 minutes) and median postoperative stay was 6.5 days (range 2-27 days). There was neither mortality nor cases of intraoperative complications were described. No postoperative major complications were reported; however one patient presented important pain in his right hemithorax that required management and long term follow-up by the Pain Management Unit. With a mean follow-up of 165.57 months (median 170; range 29-336 months) no recurrences were reported.Conclusion: Enucleation is the treatment of choice for the majority of esophageal leiomyomas. In our experience, duration of the surgical procedure through minimally invasive approach was longer than surgery through open approach; however, postoperative stay was shorter in the first group. Paradoxically, incision pain after surgery (thoracic neuralgia) was found to be higher in the minimally invasive approach group. Nevertheless, none of the results obtained in the study reached statistical significance, probably due to the small simple size.

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Section: Discussionmentioning

confidence: 93%

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

et al. 2015

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“…Currently, >20 studies have been published with outcome data based on >700 patients (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)22,29,30,(32)(33)(34)(35). In these studies, therapeutic success was recorded for >77% of patients and en bloc resection was achieved in >85% of patients, while irregularly shaped or larger tumors were risk factors in piecemeal resection (33).…”

Section: Efficacy Of Stermentioning

confidence: 99%

“…To the best of our knowledge, there are no randomized, controlled trials comparing STER with other treatments of SMTs, but three retrospective studies have been published. (34) retrospectively assessed the clinical data of 39 patients with esophageal leiomyoma, 18 of which received STER and 21 of which received ESD, and demonstrated that the efficacy and complications of the two techniques were comparable, though STER was associated with decreased operating time and duration of hospital stay, and an increased rate of incision healing compared with ESD.…”

Section: Efficacy Of Stermentioning

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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“…A 3-5 cm long submucosal tunnel functions as a good "leak-proof structure" and could reduce the potential risk of gastrointestinal tract leakage (air and/or fluid) and prevent secondary infection. Wang et al (29) demonstrated that STER has advantages over ESD in terms of promoting a rapid wound healing and reducing the operating time and hospital stay without compromising the success rate or increasing complications. With regard to SMTs > 10 mm, STER is the preferable choice compared with ESE with regard to the prevention of air leakage symptoms (30).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Results: A total of 43 patients were enrolled: 15 underwent STER and the remaining 28 cases underwent EFTR. There were no significant differences between the two groups with regard to gender, age, tumor size, en bloc resection rate, operation time, pathohistological results and cost (p > 0.05). However, patients who underwent EFTR had a longer suture time, required a larger number of clips for closure and a prolonged postoperative hospital stay (p < 0.05). No recurrence was noted in either the STER or the EFTR group during a mean follow-up of 12.1 and 22.8 months, respectively. Conclusions:The treatment efficacy of STER and EFTR for the treatment of gastric fundus SMTs was comparable. However, STER has some advantages over EFTR in terms of suture time, the number of clips required for closure and postoperative hospital stay.

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Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma

Abstract: ESTD is a safe and effective treatment for esophageal leiomyoma, with advantages over ESD.

Cited by 58 publications

References 27 publications

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

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

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

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