Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

Lü, Jiangang; Jiao, Taotao; Zheng, Minhua; Lu, Xuefeng

doi:10.1007/s00464-014-3610-y

Cited by 68 publications

(51 citation statements)

References 16 publications

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“…Currently, >20 studies have been published with outcome data based on >700 patients (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)22,29,30,(32)(33)(34)(35). In these studies, therapeutic success was recorded for >77% of patients and en bloc resection was achieved in >85% of patients, while irregularly shaped or larger tumors were risk factors in piecemeal resection (33).…”

Section: Efficacy Of Stermentioning

confidence: 99%

“…Lu et al (35) retrospectively analyzed the clinical data of 77 patients with upper gastrointestinal SMTs, 42 of which received STER and 35 of which received ESE, and demonstrated that the efficacy and complications of the two techniques were comparable, though STER decreased air leakage for SMTs by >10 mm compared with ESE. (32) retrospectively evaluated the clinical data of 31 patients with esophageal leiomyoma (diameter, 35-55 mm), 18 of which received STER and 13 of which received VATS, and revealed that the efficacy of the two techniques were comparable, though STER was associated with decreased operation time, a reduced decrease in hemoglobin level, and decreased cost and duration of hospital stay compared with VATS.…”

Section: Comparing Ster and Esd Wang Et Almentioning

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: Efficacy Of Stermentioning

confidence: 99%

Section: Comparing Ster and Esd Wang Et Almentioning

confidence: 99%

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

2017

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“…[15][16][17][18][19] However, for multiple SMTs, repeated resections by STER procedure in a different tunnel seems to be a time-consuming effort and make patients suffer too much. In this study, we first focused on using STER technique to resect upper GI multiple SMTs originating from the MP layer.…”

Section: Discussionmentioning

confidence: 99%

Submucosal tunneling endoscopic resection for upper gastrointestinal multiple submucosal tumors originating from the muscular propria layer: A feasibility study

Zhang

Chen

et al. 2014

Indian J Cancer

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“…Wang et al (29) demonstrated that STER has advantages over ESD in terms of promoting a rapid wound healing and reducing the operating time and hospital stay without compromising the success rate or increasing complications. With regard to SMTs > 10 mm, STER is the preferable choice compared with ESE with regard to the prevention of air leakage symptoms (30). However, little is known about how the STER and EFTR procedures compare for the treatment of gastric fundus SMTs.…”

Section: Discussionmentioning

confidence: 99%

A comparison of submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric fundus submucosal tumors

et al. 2017

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Results: A total of 43 patients were enrolled: 15 underwent STER and the remaining 28 cases underwent EFTR. There were no significant differences between the two groups with regard to gender, age, tumor size, en bloc resection rate, operation time, pathohistological results and cost (p > 0.05). However, patients who underwent EFTR had a longer suture time, required a larger number of clips for closure and a prolonged postoperative hospital stay (p < 0.05). No recurrence was noted in either the STER or the EFTR group during a mean follow-up of 12.1 and 22.8 months, respectively. Conclusions:The treatment efficacy of STER and EFTR for the treatment of gastric fundus SMTs was comparable. However, STER has some advantages over EFTR in terms of suture time, the number of clips required for closure and postoperative hospital stay.

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Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

Cited by 68 publications

References 16 publications

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

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

Submucosal tunneling endoscopic resection for upper gastrointestinal multiple submucosal tumors originating from the muscular propria layer: A feasibility study

A comparison of submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric fundus submucosal tumors

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