Submucosal 1-tunnel endoscopic resection for treating upper gastrointestinal multiple submucosal tumor originating from the muscularis propria layer

Abstract

To explore the feasibility and efficacy of submucosal 1-tunnel endoscopic resection (1-tunnel STER) for the treatment of multiple upper gastrointestinal submucosal tumors (GI-SMTs) originating from the muscularis propria (MP) layer. A total of 12 patients with multiple upper GI-SMTs (no less than 2 SMTs) who underwent 1-tunnel STER from April 2013 to October 2017 were included. Clinical data on general characteristics, operation-related parameters, adverse events, and follow-up results were recorded and analyzed. All 12 patients underwent 1-tunnel STER successfully, and the mean operation time was 92.1 ± 40.8 minutes. A total of 30 SMTs were resected, out of which 27 were in the esophagus and 3 were in the stomach. The mean diameter was 15.0 ± 8.2 mm (range, 3–38 mm). All the SMTs were resected en bloc uneventfully. The SMTs comprised 28 leiomyomas and 2 gastric stromal tumors (low risk). No recurrence was noticed during a mean follow-up of 24.9 ± 15.3 months (range, 1–52 months). One-tunnel STER may serve as a feasible and effective technique for the treatment of multiple upper GI-SMTs originating from the MP layer. A large-scale prospective study is warranted for a confirmative conclusion.

Complete laparoscopic-transhiatal removal of duplex benign oesophageal tumour: case report and review of literature

“…A recent meta-analysis on STER demonstrated an en bloc resection rate of 94.9%, with overall gas-related and inflammation-related adverse events rates of 21.5% and 8.4%, respectively, a postinterventional bleeding rate of 2.2%, and length of hospital stay of a median of 3.8 days [26]. Wang et al published excellent outcomes with the STER procedure by successfully removing multiple leiomyomas with a mean diameter of 15 mm in 12 patients [27]. In a prospective, comparative study with 66 patients, STER and VATS were investigated.…”

Esophageal intramural squamous cell carcinomas presenting as subepithelial lesions removed by endoscopic submucosal dissection

“…[ 19 , 20 ] Furthermore, several studies revealed that endoscopy could achieve en bloc resection in case of esophageal GISTs, and endoscopic resection is safe, effective, and minimally invasive. [ 2 , 8 , 21 , 22 ] Moreover, several lymphomas presented as SELs and treated with endoscopic resection have been reported. [ 23 – 27 ] In addition, according to the literature review, some other rare cases were treated with endoscopy, similar to follicular dendritic cell sarcoma and adenoid cystic carcinoma.…”

Application of NOTES combined with ESD for the treatment of an exogenous gastric stromal tumor: A case report and review of the literature

“…During the surgery, the tumor must be excised from the submucosa or inner muscle layer along the external edge of the tumor, and the capsule of the tumor must remain intact. STER technology is close to endoscopic myotomy (POEM) (33), which involves a tunnel to treat multiple lesions (34). However, the space inside of the tunnel is limited, and the operation and removal of large lesions are difficult.…”