Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layerReport as inadecuate




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BMC Gastroenterology

, 12:124

Gastroesophageal disorders

Abstract

BackgroundGastric subepithelial tumors are usually asymptomatic and observed incidentally during endoscopic examination. Although most of these tumors are considered benign, some have a potential for malignant transformation, particularly those originating from the muscularis propria layer. For this type of tumor, surgical resection is the standard treatment of choice. With recent advent of endoscopic resection techniques and devices, endoscopic submucosal dissection ESD has been considered as an alternative way of treatment. The aim of this study is to demonstrate the feasibility of a modified ESD technique with enucleation for removal of gastric subepithelial tumors originating from the muscularis propria layer, and to evaluate its efficacy and safety.

MethodsFrom November 2009 to May 2011, a total of 16 patients received a modified ESD with enucleation for their subepithelial tumors. All tumors were smaller than 5 cm and originated from the muscularis propria layer of the stomach, as shown by endoscopic ultrasonography EUS. The procedure was conducted with an insulated-tip knife 2. Patient’s demographics, tumor size and pathological diagnosis, procedure time, procedure-related complication, and treatment outcome were reviewed.

ResultsFifteen of the sixteen tumors were successful complete resection. The mean tumor size measured by EUS was 26.1 mm range: 20–42 mm. The mean procedure time was 52 minutes range: 30–120 minutes. Endoscopic features of the 4 tumors were pedunculated and 12 were sessile. Their immunohistochemical diagnosis was c-kit + stromal tumor in 14 patients and leiomyoma in 2 patients. There was no procedure-related perforation or overt bleeding. During a mean follow up duration of 14.8 months range: 6–22 months, there was no tumor recurrence or metastasis.

ConclusionsUsing a modified ESD with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer and larger than 2 cm, complete resection can be successfully performed without serious complication. It is a safe and effective alternative to surgical therapy for these tumors of 2 to 5 cm in size.

KeywordsEndoscopic submucosal dissection Gastrointestinal stromal tumors Endoscopic ultrasonography AbbreviationsESDEndoscopic Submucosal Dissection

GISTGastrointestinal Stromal Tumors

EUSEndoscopic Ultrasonography

EUS-FNACEUS-guided Fine Needle Aspiration for Cytology

EMREndoscopic Mucosal Resection

CTComputed tomography

IT-knife 2Insulated-tip knife 2.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-230X-12-124 contains supplementary material, which is available to authorized users.

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Author: Yin-Yi Chu - Jau-Min Lien - Ming-Hung Tsai - Cheng-Tang Chiu - Tse-Ching Chen - Kuo-Ching Yang - Soh-Ching Ng

Source: https://link.springer.com/



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