Efficacy and complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors and exploration for influencing factors

Song, Shunzhe; Wang, Xu; Zhang, Shen; Li, Yanxia; Zhang, Xiaonan; Chu, Xufang

doi:10.1055/s-0043-123765

Cited by 15 publications

(9 citation statements)

References 29 publications

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“…Gas-related and inflammation-related complications were the major complications for STER according to previous study, such as subcutaneous emphysema, pneumothorax, and pleural effusion [19]. While in our study, only 1 patient developed moderate fever and mucosal nonunion.…”

Section: Discussionmentioning

confidence: 38%

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Comparison Between Submucosal Tunneling Endoscopic Resection (STER) and Other Resection Modules for Esophageal Muscularis Propria Tumors: A Retrospective Study

Zhang

2019

Med Sci Monit

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Background Surgery has been considered to be the primary approach for resection of esophageal muscularis propria tumors. With the development of endoscopic technology, new techniques such as endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) have emerged for resecting these lesions. Previous studies have demonstrated that STER might be an intriguing alternative. This study aimed to evaluate the clinical value of STER by comparing it to other resecting modules. Material/Methods Clinical outcome and data were retrospectively collected from patients with esophageal muscularis propria tumors who underwent resection either endoscopically or thoracoscopically. The clinical data were statistically analyzed. Results A total of 137 patients were enrolled. They were divided into 3 groups: a STER group (27 patients), an ESD group (42 patients), and a thoracoscopic enucleation (TE) group (68 patients). There were no significant differences among the 3 groups in gender, age, pathological type of tumors, or major adverse events (P>0.05). However, the STER group had the shortest duration of hospitalization and the lowest cost (P<0.05). Furthermore, the STER group was superior in operation time and the location of tumors to the TE group. Moreover, STER outperformed ESD in the resection of large tumors (P<0.05). Although STER had the lowest en bloc resection rate, no recurrence or metastasis was noted during a mean follow-up of 22.14 months (range 3 to 60 months). Conclusions STER is a feasible, safe, and effective approach for the resection of esophageal muscularis propria tumors ≤40 mm. We recommend STER as a potent alternative for these tumors.

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Section: Discussionmentioning

confidence: 38%

“…Management of SMTs originating from the MP layers remains a controversial topic [19]. In the past, open or thoracoscopic surgery was performed to remove SMTs, even without accurate orientation.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Submucosal Tunneling Endoscopic Resection (STER) and Other Resection Modules for Esophageal Muscularis Propria Tumors: A Retrospective Study

Zhang

2019

Med Sci Monit

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“…The STER-related complication rates mainly range from 5% to 25% with no reported deaths, and most of the complications reported are mild[14], which is in accordance with our results. A meta-analysis involving 12 studies including 397 patients and 430 lesions showed that the pooled complication rate of STER for GI SMTs was 21.5% (95%CI: 13.2-33.1%)[25]. Gas-related complications are regarded as the most common complication related to STER[28,35,45,46,48].…”

Section: Discussionmentioning

confidence: 99%

Submucosal tunneling endoscopic resection: An effective and safe therapy for upper gastrointestinal submucosal tumors originating from the muscularis propria layer

Du¹,

Chai²,

Linghu³

et al. 2019

WJG

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AIMTo evaluate the effectiveness and safety of submucosal tunneling endoscopic resection (STER) and compare its outcomes in esophageal and cardial submucosal tumors (SMTs) of the muscularis propria (MP) layer.METHODSFrom May 2012 to November 2017, 173 consecutive patients with upper gastrointestinal (GI) SMTs of the MP layer underwent STER. Overall, 165 patients were included, and 8 were excluded. The baseline characteristics of the patients and SMTs were recorded. The en bloc resection rate, complete resection rate, residual rate, and recurrence rate were calculated to evaluate the effectiveness of STER, and the complication rate was recorded to evaluate its safety. Effectiveness and safety outcomes were compared between esophageal and cardial SMTs.RESULTSOne hundred and twelve men and 53 women with a mean age of 46.9 ± 10.8 years were included. The mean tumor size was 22.6 ± 13.6 mm. Eleven SMTs were located in the upper esophagus (6.7%), 49 in the middle esophagus (29.7%), 46 in the lower esophagus (27.9%), and 59 in the cardia (35.7%). Irregular lesions accounted for 48.5% of all lesions. STER achieved an en bloc resection rate of 78.7% (128/165) for GI SMTs with an overall complication rate of 21.2% (35/165). All complications resolved without intervention or were treated conservatively without the need for surgery. The en bloc resection rates of esophageal and cardial SMTs were 81.1% (86/106) and 72.1% (42/59), respectively (P = 0.142), and the complication rates were 19.8% (21/106) and 23.7% (14/59), respectively, (P = 0.555). The most common complications for esophageal SMTs were gas-related complications and fever, while mucosal injury was the most common for cardial SMTs.CONCLUSIONSTER is an effective and safe therapy for GI SMTs of the MP layer. Its effectiveness and safety are comparable between SMTs of the esophagus and cardia.

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“…5,[31][32][33] A meta-analysis involving 12 studies including 397 patients and 430 lesions showed that the pooled complication rate of STER is 21.5% (95% confidence interval [CI], 13.2-33.1). 34 Gas related events are most com- monly observed during STER. In a systematic review, the pooled prevalence of gas-related events was 14.8% (95% CI, 10.5-20.5) for subcutaneous emphysema and pneumomediastinum, 6.1% (95% CI, 4.0-9.0) for pneumothorax, and 6.8% (95% CI, 4.7-9.6) for pneumoperitoneum.…”

Section: Stermentioning

confidence: 99%

“…35 Gas related complications occur more frequently in esophageal tumors and mucosal injuries were seen in cardia tumor. 33,34 The main reason for differences in the complications between esophageal and cardia tumor is the absence of serosa in esophagus and a thicker muscularis propria (MP) in cardia which reduces the likelihood of gas related complication. In addition, the complex anatomy of cardia increases the risk of mucosal injury.…”

Section: Stermentioning

confidence: 99%

Adverse events associated with third space endoscopy: Diagnosis and management

Chavan

Nabi

Reddy

2020

Int J Gastrointest Interv

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Third space endoscopy (TSE) is a 'magnum opus' in the field of therapeutic gastrointestinal (GI) endoscopy that has led to a paradigm shift in the management of various GI disorders. TSE or submucosal endoscopy is based on the concept of mucosal flap safety valve technique. Since, the basic principle is more or less similar for all the TSE procedures, the nature of major adverse events (AE) also shares some similarity across the spectrum of TSE procedures. These AE include insufflation related AE, bleeding, perforation, and infection. Insufflation related events are among the most commonly encountered AEs. However, majority of the insufflation related AE do not require a specific intervention and not regarded as AE in true sense. Identification of risk factors and adaptation of preventative strategies may help in reducing the incidence of AE. At the same time, early recognition and expeditious management is paramount to reduce morbidities associated with these AE. Due to heterogeneity in the reporting of AE, it is difficult to estimate the actual incidence of AE and compare the results between different studies. Therefore, universal adaptation of a standard reporting system is required to quantify the true incidence of AE for each procedure.

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Efficacy and complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors and exploration for influencing factors

Cited by 15 publications

References 29 publications

Comparison Between Submucosal Tunneling Endoscopic Resection (STER) and Other Resection Modules for Esophageal Muscularis Propria Tumors: A Retrospective Study

Comparison Between Submucosal Tunneling Endoscopic Resection (STER) and Other Resection Modules for Esophageal Muscularis Propria Tumors: A Retrospective Study

Submucosal tunneling endoscopic resection: An effective and safe therapy for upper gastrointestinal submucosal tumors originating from the muscularis propria layer

Adverse events associated with third space endoscopy: Diagnosis and management

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