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Published in:

01-03-2018

Factors affecting the effectiveness and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors originating from the muscularis propria layer

Authors: Chen Du, Lianjun Ma, Ningli Chai, Ying Gao, Xiaotong Niu, Yaqi Zhai, Zhenjuan Li, Jiangyun Meng, Ping Tang, Enqiang Linghu

Published in: Surgical Endoscopy | Issue 3/2018

Abstract

Background and aims

Submucosal tunneling endoscopic resection (STER) has been proved to be effective and safe for esophageal submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. This study was aimed to further evaluate the effectiveness, safety, and influencing factors especially the types of mucosal incision of STER in a larger population.

Methods

A total of 89 patients undergoing STER with esophageal SMTs were retrospectively enrolled in this study from May 2012 to November 2016. Clinicopathological, endoscopic, and adverse events (AEs) data were collected and analyzed. Different incision methods were compared to evaluate the optimum incision method.

Results

There were 27 females and 62 males with mean age of 46.5 ± 10.3 years. The medium size of the tumors was 16.0 mm (ranging 10.0–60.0 mm). Inverted T incisions were made in 29 (32.6%) patients, transverse incisions in 12 (13.5%) while longitudinal incisions in 48 (53.9%). En bloc resection was achieved in 70 (78.7%) patients. The residual rate was 1.1% (1/89), and no recurrence was noted even after piecemeal resection. The rate of AEs was 21.3% (19/89), and all of the AEs were cured without intervention or treated conservatively without the need for surgery. The en bloc resection rate was comparable among the three incision groups (P = 0.868); however, the incidence of AEs in the inverted T incision was lower than that in the longitudinal incision (P = 0.003). Fewer clips were used in the inverted T incision group than in the transverse incision group (P = 0.003).

Conclusions

Although STER failed to achieve en bloc resection in 21.3% patients, it was still an effective therapy owing to low residual rate and no recurrence rate after piecemeal resection. STER was safe with no severe AEs; however, minor AEs were common. Inverted T incision seems to be the optimum entry point.

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Nishida T, Kawai N, Yamaguchi S, Nishida Y (2013) Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endos 25(5):479–489. doi:10.1111/den.12149 CrossRef

Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 8(Suppl 2):S1–41 quiz S42–44 CrossRefPubMedPubMedCentral

Punpale A, Rangole A, Bhambhani N, Karimundackal G, Desai N, de Souza A, Pramesh CS, Jambhekar N, Mistry RC (2007) Leiomyoma of esophagus. Ann Thorac Cardiovasc Surg 13(2):78–81PubMed

American Gastroenterological Association I (2006) American Gastroenterological Association Institute medical position statement on the management of gastric subepithelial masses. Gastroenterology 130(7):2215–2216. doi:10.1053/j.gastro.2006.04.032 CrossRef

Otani Y, Furukawa T, Yoshida M, Saikawa Y, Wada N, Ueda M, Kubota T, Mukai M, Kameyama K, Sugino Y, Kumai K, Kitajima M (2006) Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 139(4):484–492. doi:10.1016/j.surg.2005.08.011 CrossRefPubMed

Wang H, Tan Y, Zhou Y, Wang Y, Li C, Zhou J, Duan T, Zhang J, Liu D (2015) Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol 27(7):776–780. doi:10.1097/MEG.0000000000000394 CrossRefPubMed

Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75(1):195–199. doi:10.1016/j.gie.2011.08.018 CrossRefPubMed

Kim GH (2012) Endoscopic resection of subepithelial tumors. Clin Endosc 45(3):240–244. doi:10.5946/ce.2012.45.3.240 CrossRefPubMedPubMedCentral

Tan Y, Lv L, Duan T, Zhou J, Peng D, Tang Y, Liu D (2016) Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer. Surg Endosc 30(7):3121–3127. doi:10.1007/s00464-015-4567-1 CrossRefPubMed

10.

Meng FS, Zhang ZH, Hong YY, Li DJ, Lin JQ, Chen X, Ji F (2016) Comparison of endoscopic submucosal dissection and surgery for the treatment of gastric submucosal tumors originating from the muscularis propria layer: a single-center study (with video). Surg Endosc 30(11):5099–5107. doi:10.1007/s00464-016-4860-7 CrossRefPubMed

11.

Stavropoulos SN, Modayil R, Friedel D, Brathwaite CE (2014) Endoscopic full-thickness resection for GI stromal tumors. Gastrointest Endosc 80(2):334–335. doi:10.1016/j.gie.2014.05.300 CrossRefPubMed

12.

Ye LP, Zhang Y, Wang CY, He SQ, Feng XJ, Zhang JS, Ding JX (2012) Endoscopic submucosal enucleation for gastric submucosal tumors originated from muscularis propria layer: clinical analysis of 116 case. Zhonghua Wei Chang Wai Ke Za Zhi 15(11):1175–1177PubMed

13.

Reinehr R (2015) Endoscopic submucosal excavation (ESE) is a safe and useful technique for endoscopic removal of submucosal tumors of the stomach and the esophagus in selected cases. Z Gastroenterol 53(6):573–578. doi:10.1055/s-0034-1399384 CrossRefPubMed

14.

Goto O, Uraoka T, Horii J, Yahagi N (2014) Expanding indications for ESD: submucosal disease (SMT/carcinoid tumors). Gastrointest Endosc Clin N Am 24(2):169–181. doi:10.1016/j.giec.2013.11.006 CrossRefPubMed

15.

Linghu EQ, Zhang YC (2011) Experimental study on resection of the esophageal muscular propria layer by endoscopic tunnel technique. Chin J Laparoscopic Surgery(Electronic Edition) 4(5):392–393

16.

Zhou DJ, Dai ZB, Wells MM, Yu DL, Zhang J, Zhang L (2015) Submucosal tunneling and endoscopic resection of submucosal tumors at the esophagogastric junction. World J Gastroenterol 21(2):578–583. doi:10.3748/wjg.v21.i2.578 CrossRefPubMedPubMedCentral

17.

Mao XL, Ye LP, Zheng HH, Zhou XB, Zhu LH, Zhang Y (2016) Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer. Dis Esophagus. doi:10.1111/dote.12536

18.

Lu J, Jiao T, Zheng M, Lu X (2014) Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection. Surg Endosc 28(12):3401–3407. doi:10.1007/s00464-014-3610-y CrossRefPubMed

19.

Chen T, Zhang C, Yao LQ, Zhou PH, Zhong YS, Zhang YQ, Chen WF, Li QL, Cai MY, Chu Y, Xu MD (2016) Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Endoscopy 48(2):149–155. doi:10.1055/s-0034-1393244 PubMed

20.

Shi Q, Zhong YS, Yao LQ, Zhou PH, Xu MD, Wang P (2011) Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc 74(6):1194–1200. doi:10.1016/j.gie.2011.07.039 CrossRefPubMed

21.

Abe N, Takeuchi H, Ooki A, Nagao G, Masaki T, Mori T, Sugiyama M (2013) Recent developments in gastric endoscopic submucosal dissection: towards the era of endoscopic resection of layers deeper than the submucosa. Dig Endosc 25(Suppl 1):64–70. doi:10.1111/j.1443-1661.2012.01387.x CrossRefPubMed

22.

Walz B, von Renteln D, Schmidt A, Caca K (2011) Endoscopic full-thickness resection of subepithelial tumors with the use of resorbable sutures (with video). Gastrointest Endosc 73(6):1288–1291. doi:10.1016/j.gie.2011.01.052 CrossRefPubMed

23.

Zhou PH, Yao LQ, Qin XY, Cai MY, Xu MD, Zhong YS, Chen WF, Zhang YQ, Qin WZ, Hu JW, Liu JZ (2011) Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 25(9):2926–2931. doi:10.1007/s00464-011-1644-y CrossRefPubMed

24.

Tan Y, Tang X, Guo T, Peng D, Tang Y, Duan T, Wang X, Lv L, Huo J, Liu D (2016) Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer. Surg Endosc. doi:10.1007/s00464-016-5350-7 PubMedCentral

25.

Li QL, Chen WF, Zhang C, Hu JW, Zhou PH, Zhang YQ, Zhong YS, Yao LQ, Xu MD (2015) Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc 29(12):3640–3646. doi:10.1007/s00464-015-4120-2 CrossRefPubMed

26.

Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42(4):265–271. doi:10.1055/s-0029-1244080 CrossRefPubMed

27.

Liu H, Wei LL, Zhang YZ, Sha QM, Huang Y, Qin CY, Xu HW (2015) Submucosal tunnelling endoscopic resection (STER) for the treatment of a case of huge esophageal tumor arising in the muscularis propria: a case report and review of literature. Int J Clin Exp Med 8(9):15846–15851PubMedPubMedCentral

28.

Zhang C, Hu JW, Chen T, Zhou PH, Zhong YS, Zhang YQ, Chen WF, Li QL, Yao LQ, Xu MD (2015) Submucosal tunneling endoscopic resection for upper gastrointestinal multiple submucosal tumors originating from the muscular propria layer: a feasibility study. Indian J Cancer 51(Suppl 2):e52–55. doi:10.4103/0019-509X.151989 PubMed

29.

Liu BR, Song JT (2016) Submucosal tunneling endoscopic resection (STER) and other novel applications of submucosal tunneling in humans. Gastrointest Endosc Clin N Am 26(2):271–282. doi:10.1016/j.giec.2015.12.003 CrossRefPubMed

30.

Chen T, Zhou PH, Chu Y, Zhang YQ, Chen WF, Ji Y, Yao LQ, Xu MD (2017) Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg 265(2):363–369. doi:10.1097/SLA.0000000000001650 CrossRefPubMed

31.

Wang XY, Xu MD, Yao LQ, Zhou PH, Pleskow D, Li QL, Zhang YQ, Chen WF, Zhong YS (2014) Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos). Surg Endosc 28(6):1971–1977. doi:10.1007/s00464-014-3420-2 CrossRefPubMed

32.

Ma XB, Linghu EQ, Li HK, Zhai YQ, Chai NL, Peng LH, Wang XD, Du H, Meng JY, Wang HB, Zhu J, Guo MZ, Wang XX, Lu ZS (2016) Factors affecting the safety and efficacy of peroral endoscopic myotomy for achalasia. Nan Fang Yi Ke Da Xue Xue Bao 36(7):892–897PubMed

Title: Factors affecting the effectiveness and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors originating from the muscularis propria layer
Authors: Chen Du
Lianjun Ma
Ningli Chai
Ying Gao
Xiaotong Niu
Yaqi Zhai
Zhenjuan Li
Jiangyun Meng
Ping Tang
Enqiang Linghu
Publication date: 01-03-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5800-x

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Factors affecting the effectiveness and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors originating from the muscularis propria layer

Abstract

Background and aims

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

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Abstract

Background and aims

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Conclusions

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