Efficiency and safety of endoscopic resection in the management of subepithelial lesions of the stomach

Abstract

Background: Gastric subepithelial tumors represent a diagnostic and therapeutic challenge, given their histologic heterogeneity and potential malignant behavior. Objective: The objective of this article is to evaluate the interest, efficiency and safety of endoscopic resection for subepithelial gastric lesions of size <20 mm. Methods: We conducted a single-center retrospective study in a tertiary care center. Results: A total of 33 lesions (10 malignant/23 benign lesions) were studied. Mean histological size was 14.5 mm. Nine EMR, 18 ESD and six hybrid resections were performed. A total of 93.9% lesions were resected in one piece. At six months' follow-up, complete and definitive resection was obtained in 96.7% of cases. A vertical resection was insufficient in four cases. One GIST needed a complementary surgical resection, one neuroendocrine tumor was successfully treated by a new ESD session and two pancreatic rests were not additionally treated given the benign character and the absence of residual tissue in endoscopic control after six months. There was only one severe adverse event (2.9%); one pneumoperitoneum with ESD, three bleeding with one ESD and two EMR, always treated conservatively or endoscopically. Conclusion: Endoscopic resection is safe and should be the procedure of choice for both diagnosis and definitive resection of subepithelial gastric lesions of size under 20 mm.

Endoscopic Submucosal Dissection Outcomes for Gastroesophageal Tumors in Low Volume Units: A Multicenter Survey

“…Several other case series have recently reported successful ESD for various gastric submucosal tumors such as ectopic pancreas, ectopic spleen, leiomyoma, and gastrointestinal stromal tumor (GIST) [23, 24]. In another case series from France, the authors reported successful resection of 33 submucosal lesions in the stomach for lesions <20 mm, with the majority of lesions being resected by ESD [25]. In this study, 6 lesions dissected were submucosal in origin.…”

Gastroduodenal Intussusception with a Gastric Gastrointestinal Stromal Tumor Treated by Endoscopic Submucosal Dissection

“…Several authors have described the usefulness of ESD for small and asymptomatic gastric submucosal tumors ( 16 , 17 ). It was recently reported that endoscopic resection of subepithelial tumors of the stomach has a high success rate with few adverse events ( 18 ). In the present case, EUS suggested that the tumor was located within the submucosal layer without involvement of the muscular layer.…”

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

“…Weak recommendation, low quality evidence) more reliable determination of the mitotic count and Ki67 labeling index compared with EUS-guided sampling [110]. However, such aggressive techniques that use a knife or a snare to expose the SEL surface for biopsy sampling are inadequate for deep SELs (e. g., fourth EUS layer with protrusion to the peritoneal side) and are neither standardized nor widespread [111,112].…”