Philip Wai Yan Chiu1, Hon Chi Yip2, Anthony Yuen Bun Teoh2, Vivien Wai Yin Wong2, Shannon Melissa Chan2, Simon Kin Hung Wong2, Enders Kwok Wai Ng2. 1. Division of Upper GI and Metabolic Surgery, Department of Surgery and State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong S.A.R., The People's Republic of China. philipchiu@surgery.cuhk.edu.hk. 2. Division of Upper GI and Metabolic Surgery, Department of Surgery and State Key Laboratory of Digestive Diseases, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong S.A.R., The People's Republic of China.
Abstract
BACKGROUND: Endoscopic submucosal tunneling has evolved to allow endoscopic resection of subepithelial tumors of gastrointestinal tract without full-thickness perforation. This study aimed to investigate safety and efficacy of submucosal tunnel resection for these tumors. METHOD: Patients with subepithelial tumors (SET) located in esophagus, gastric cardia, lesser curvature, and antrum were recruited. The size of tumor was limited to < 40 mm. The procedures were performed under general anesthesia. A mucosal entrance was created 2 cm proximal to the SET after submucosal injection. Submucosal tunnel was then extended and the tumor was dissected and mobilized with intact overlying mucosa. After complete dissection, the tumors would be retrieved per orally and mucosal entrance closed by endoclips. RESULTS: From June 2012 to December 2016, 51 patients with subepithelial tumors received POET. 39 patients had SET in stomach, 11 located in esophagus, and 1 in duodenum. The mean operative time was 90.46 ± 46.49 min, while the mean size of the tumors was 20.71 ± 14.05 mm. The POET was converted to endoscopic full-thickness resection (EFTR) in three patients with gastric subepithelial tumors located at greater curvature. The overall complication rate was 4.0%, and there was no bleeding, mucosal dehiscence, or leakage. The time to resume diet was 1.7 days, while the average hospital stay was 3.2 ± 1.0 days. The mean follow-up period was 19 ± 16 months, and only 1 patient developed recurrence of leiomyoma. CONCLUSION: Per oral endoscopic tumor resection is safe and effective treatment for esophageal and gastric SET located at cardia, lesser curvature, and antrum. Currently, POET for treatment of upper GI SET is limited by the size and location of the tumor.
BACKGROUND: Endoscopic submucosal tunneling has evolved to allow endoscopic resection of subepithelial tumors of gastrointestinal tract without full-thickness perforation. This study aimed to investigate safety and efficacy of submucosal tunnel resection for these tumors. METHOD: Patients with subepithelial tumors (SET) located in esophagus, gastric cardia, lesser curvature, and antrum were recruited. The size of tumor was limited to < 40 mm. The procedures were performed under general anesthesia. A mucosal entrance was created 2 cm proximal to the SET after submucosal injection. Submucosal tunnel was then extended and the tumor was dissected and mobilized with intact overlying mucosa. After complete dissection, the tumors would be retrieved per orally and mucosal entrance closed by endoclips. RESULTS: From June 2012 to December 2016, 51 patients with subepithelial tumors received POET. 39 patients had SET in stomach, 11 located in esophagus, and 1 in duodenum. The mean operative time was 90.46 ± 46.49 min, while the mean size of the tumors was 20.71 ± 14.05 mm. The POET was converted to endoscopic full-thickness resection (EFTR) in three patients with gastric subepithelial tumors located at greater curvature. The overall complication rate was 4.0%, and there was no bleeding, mucosal dehiscence, or leakage. The time to resume diet was 1.7 days, while the average hospital stay was 3.2 ± 1.0 days. The mean follow-up period was 19 ± 16 months, and only 1 patient developed recurrence of leiomyoma. CONCLUSION: Per oral endoscopic tumor resection is safe and effective treatment for esophageal and gastric SET located at cardia, lesser curvature, and antrum. Currently, POET for treatment of upper GI SET is limited by the size and location of the tumor.
Authors: H Inoue; H Minami; Y Kobayashi; Y Sato; M Kaga; M Suzuki; H Satodate; N Odaka; H Itoh; S Kudo Journal: Endoscopy Date: 2010-03-30 Impact factor: 10.093
Authors: Philip Wai Yan Chiu; Justin Che Yuen Wu; Anthony Yuen Bun Teoh; Yawen Chan; Simon Kin Hung Wong; Shirley Yuk Wah Liu; Man Yee Yung; Candice C H Lam; Joseph Jao Yiu Sung; Francis Ka Leung Chan; James Yun Wong Lau; Enders Kwok Wai Ng Journal: Gastrointest Endosc Date: 2012-10-06 Impact factor: 9.427