Submucosal tunnel endoscopic resection for extraluminal tumors: a novel endoscopic method for en bloc resection of predominant extraluminal growing subepithelial tumors or extra-gastrointestinal tumors (with videos)

Cai, Mingjun; Zhu, Boqun; Xu, Mei‐Dong; Qin, Wen‐Zheng; Zhang, Yiqun; Chen, Weifeng; Ooi, Marie; Li, Quan‐Lin; Yao, Ling; Zhou, Ping‐Hong

doi:10.1016/j.gie.2018.02.032

Cited by 34 publications

(18 citation statements)

References 20 publications

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“…Subsequently, our center reported about the use of STER to treat esophageal and cardiac SMTs [16]. An increasing number of researchers from China and across the world have successively explored the STER technique [17–20]. The safety and efficacy of STER for treating esophageal SMTs have been verified by a large number of clinical studies [21, 22].…”

Section: Discussionmentioning

confidence: 99%

Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study

Huang

et al. 2018

Gastroenterology Research and Practice

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Background Submucosal tumors (SMTs) are primarily benign tumors, but some may have a malignant potential. Endoscopic submucosal dissection that has been used for removing esophageal SMTs could cause perforation. Submucosal tunnel endoscopic resection (STER) is an improved and an effective technique for treating esophageal SMTs. Aims This study was conducted to evaluate the efficacy and safety of STER for treating esophageal SMTs. Methods A retrospective study design was adopted to analyze the baseline characteristics, clinical outcomes, and follow-up data of patients with esophageal SMTs, which originated from the muscularis propria layer and were treated with STER from September 2011 to May 2018. Results A total of 119 lesions were included from 115 patients who were successfully treated with STER. The mean age of the patients was 49.7 ± 10.7 years. The lesions were primarily located in the middle and lower esophagus. The mean size of the lesions was 19.4 ± 10.0 mm. The mean operation duration was 46.7 ± 25.6 min, and the mean duration of hospitalization was 5.9 ± 2.8 days. The total en bloc resection rate and the complete resection rate were 97.5% and 100%, respectively. Regarding complications, there were 9 (7.8%) cases of perforation, 2 (1.7%) cases of pneumothorax, and 9 (7.8%) cases of subcutaneous emphysema. Histopathological results revealed 113 (95.0%) cases of leiomyoma, 5 (4.2%) cases of gastrointestinal stromal tumors, and 1 (0.8%) case of a granular cell tumor. During the mean 15-month follow-up, there were no cases of recurrence and distant metastasis. Conclusions STER is a safe and feasible technique for treating esophageal SMTs originating from the muscularis propria layer.

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Section: Discussionmentioning

confidence: 99%

Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study

Huang

et al. 2018

Gastroenterology Research and Practice

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“…The small GI SETs were usually treated with endoscopic mucosal resection with ligation band, whereas the larger myogenic tumors and predominant extraluminal growing tumors were mostly referred to surgery for complete and safe resection. 12 Lesions in the gastric fundus were usually referred to as surgery because the endoscopic approach is difficult for this location due to its anatomy. The procedure risk and successful rate should justify when our results are applied to clinical practice.…”

Section: F I G U R Ementioning

confidence: 99%

Management of gastrointestinal subepithelial tumors with endoscopic resection

Chou

Liao

Chen

et al. 2020

Adv in Digestive Medicine

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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

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“…Treatment of Barrett’s and early esophageal cancer - this area has seen tremendous progress in the past decade, and future areas of refinement will include indications for treatment, the optimal modality for specific and individual situations, and pushing the envelope with endoscopic resection. These resection and tunneling techniques may also be employed to remove submucosal tumors (SMTs), such as leiomyoma, by submucosal tunneling endoscopic resection (STER) technique[104-107].…”

Section: Be and Early Esophageal Cancermentioning

confidence: 99%

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Chang

2019

WJG

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In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic, the content will progress as follows: “lessons learned”, “technical considerations” and “future opportunities”. Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years. Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as “the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop”. Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula, Barrett’s esophagus (BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors. For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy (POEM) which was developed in Japan, has become an alternative to the traditional Heller’s myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker’s diverticula with improved technique (Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection (ESD) which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett’s and related dysplasia and early cancer can be managed predominantly by endoscopy. Importantly, in regard to early gastric cancer and submucosal tumors (SMTs) of the stomach, ESD and full thickness resection (FTR) can excise these lesions en-bloc and endoscopic suturing is now used to close large defects and perforations. For treatment of patients with malignant gastric outlet obstruction (GOO), endoscopic gastro-jejunostomy is now showing better results ...

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Submucosal tunnel endoscopic resection for extraluminal tumors: a novel endoscopic method for en bloc resection of predominant extraluminal growing subepithelial tumors or extra-gastrointestinal tumors (with videos)

Cited by 34 publications

References 20 publications

Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study

Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study

Management of gastrointestinal subepithelial tumors with endoscopic resection

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

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