Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer

Tan, Yuyong; Lv, Liang; Duan, Tianying; Zhou, Junfeng; Peng, Dongzi; Tang, Yu; Liu, Deliang

doi:10.1007/s00464-015-4567-1

Cited by 52 publications

(42 citation statements)

References 20 publications

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“…A further submucosal dissection of ≥0.5 cm along the sides of the longitudinal incision is made to facilitate tumor extraction and gas diffusion (15,31). For SMTs >35 mm, the mucosal incision may be increased to the size of the short dimension of the tumor (32).…”

Section: Submucosal Injectionmentioning

confidence: 99%

“…The dissection plane should be maintained proximate to the MP to decrease the risk of injury to the mucosal flap. The tunnel should be sufficiently wide and its width should increase according to the diameter of the SMT to ensure a satisfactory endoscopic view of the SMT and sufficient space for resection and facilitate submucosal dissection and gas diffusion (32).…”

Section: Submucosal Injectionmentioning

confidence: 99%

“…Complete resection without damaging the tumor capsule is recommended. For SMTs originating from the deep MP layer or exhibiting a tight connection with the underlying MP or serosal layers, a full-thickness resection, including the lesion, its underlying MP and serosa is generally performed (10,15,32). For patients with gastric SMTs undergoing full-thickness resection, the SMT should be prevented from lodging in the * Gastric corpus or fundus proximate to the cardia, the lesser curvature of the gastric corpus and the greater curvature of the gastric antrum.…”

Section: Submucosal Injectionmentioning

confidence: 99%

“…Although small SMTs may be easily removed from the tunnel and extracted from the body, doing so for SMTs >35 mm in the upper gastrointestinal tract may prove challenging. While removing SMTs from the upper gastrointestinal tract, the tumor is grasped such that its long dimensions are respectively parallel and transverse to the long axis of the esophagus, and the tumor may be easily extracted through the tunnel orifice and the upper esophageal sphincter (32). If preoperative imagery, endoscopy and clinical examination suggest a benign tumor, a snare may be used following the completion of resection to cut the tumor while still in the tunnel into ≥2 pieces to facilitate its extraction from the tunnel (32).…”

Section: Submucosal Injectionmentioning

confidence: 99%

“…While removing SMTs from the upper gastrointestinal tract, the tumor is grasped such that its long dimensions are respectively parallel and transverse to the long axis of the esophagus, and the tumor may be easily extracted through the tunnel orifice and the upper esophageal sphincter (32). If preoperative imagery, endoscopy and clinical examination suggest a benign tumor, a snare may be used following the completion of resection to cut the tumor while still in the tunnel into ≥2 pieces to facilitate its extraction from the tunnel (32). An alternative approach is to generate a second ʻwindowʼ, either in the area of the tumor or through a distal mucosal incision to facilitate en bloc extraction for large leiomyomas (24,26).…”

Section: Submucosal Injectionmentioning

confidence: 99%

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Current status of submucosal tunneling endoscopic resection for gastrointestinal submucosal tumors originating from the muscularis propria layer (Review)

2017

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Abstract.Gastrointestinal submucosal tumors (SMTs) have been increasingly identified via the use of endoscopic ultrasonography, and removal is often recommended for SMTs that are >2 cm in diameter or symptomatic. Submucosal tunneling endoscopic resection (STER), also known as submucosal endoscopic tumor resection, endoscopic submucosal tunnel dissection or tunneling endoscopic muscularis dissection, is a novel endoscopic technique for treating gastrointestinal SMTs originating from the muscularis propria layer, and has been demonstrated to be effective in the removal of SMTs with a decreased rate of recurrence by clinical studies. STER may be performed for patients with esophageal or cardia SMTs, and its application has expanded beyond these types of SMTs due to modifications to the technique. The present study reviewed the applications, procedure, efficacy and complications associated with STER. IntroductionFollowing the identification of a gastrointestinal submucosal tumor (SMT), periodic surveillance using endoscopy and endoscopic ultrasonography (EUS) remains a major strategy, but the use of this strategy is associated with multiple concerns, including patient compliance and stress, cost-effectiveness, and the risks associated with repeated endoscopic procedures and delayed diagnosis of malignancy (1,2). Furthermore, certain tumors exhibit malignant potential, particularly those that originate from the muscularis propria (MP) layer or are large in diameter (1). Therefore, removing these SMTs is crucial. Current methods to remove SMTs include surgery and endoscopic resection, compared with the latter, surgical approaches are more invasive and associated with increased costs and a longer hospital stay. Endoscopic resection is a first-line treatment for SMTs ≤50 mm in diameter (1,2). Alternative methods include endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection, but these may be associated with unsatisfactory outcomes due to incomplete resection and/or the risk of perforation during the procedure (3-5). Submucosal tunneling endoscopic resection (STER) has emerged as a novel technique for treating upper gastrointestinal SMTs and has yielded promising results (6-17). STER possesses multiple advantages over other endoscopic methods, including the maintenance of mucosal integrity, the facilitation of an increased rate of healing and a decreased risk of pleural/abdominal infection. In addition, the submucosal tunnel helps to maintain a clear visual field, which facilitates an improved response to intraoperative bleeding. The present study summarized the current status of STER, including its applications, procedure, efficacy and complications. Preoperative assessmentPrior to performing STER, the presence, originating layer, size, and the presence or absence of malignancy-associated

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Section: Submucosal Injectionmentioning

confidence: 99%

Section: Submucosal Injectionmentioning

confidence: 99%