Long-term Outcomes of Submucosal Tunneling Endoscopic Resection for Upper Gastrointestinal Submucosal Tumors

Chen, Tao; Zhou, Ping‐Hong; Chu, Yuan; Zhang, Yiqun; Chen, Weifeng; Ji, Yuan; Yao, Ling; Xu, Mei‐Dong

doi:10.1097/sla.0000000000001650

Cited by 121 publications

(88 citation statements)

References 18 publications

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“…Seventeen original articles were considered appropriate for inclusion in this review [8-24]. Two articles [14,24] were from same institute and the time frames of these studies overlapped.…”

Section: Resultsmentioning

confidence: 99%

Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria

Jain¹

2017

aog

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The management of incidentally discovered small upper gastrointestinal (GI) tract submucosal tumors (SMT) remains debatable. In this review, we summarize the evolving experience with submucosal tunneling endoscopic resection (STER) of upper GI SMTs originating from the muscularis propria. From 16 original studies, we reviewed a total of 703 patients with 736 lesions. Of these, 436 were located in the esophagus, 146 in the esophagogastric junction (EGJ) and 154 in the stomach. The composite complete resection rate (CRR) for STER of upper GI tumors arising from the muscularis propria layer was 99.8% (445/446). The composite CRR for STER of esophageal, EGJ and gastric SMTs arising from the muscularis propria layer was 100% (208/208),100% (78/78)and 100% (115/115), respectively. The composite en bloc resection rate (EBRR) for STER of upper GI tumors arising from the muscularis propria layer was 94.6% (679/718). The composite EBRR for STER of esophageal, EGJ and gastric SMTs arising from the muscularis propria layer was 98.6% (205/208), 96.2% (75/78) and 97.9% (95/97), respectively. Tumor recurrence rate was 0%. The reported complication rate for STER was high but the majority responded to conservative management. STER is a minimally invasive and efficacious alternative to surgery, especially for patients with small tumors (<3 cm). Careful selection of candidates remains crucial for excluding potentially malignant tumors.

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“…Seventeen original articles were considered appropriate for inclusion in this review [8-24]. Two articles [14,24] were from same institute and the time frames of these studies overlapped.…”

Section: Resultsmentioning

confidence: 99%

Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria

Jain¹

2017

aog

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“…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). Of the SMTs reported in these studies, >95% were leimyomas or gastrointestinal stromal tumors, while the other reported tumors included lipomas, schwannomas, calcifying fibrous, glomus, granular cell and nerve sheath tumors, proliferating collagen fibers, degenerated nodes and aberrant pancreatic tissue.…”

Section: Efficacy Of Stermentioning

confidence: 99%

“…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%

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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“…Because of the limitation of the luminal size of the submucosal tunnel established by endoscopy most of those SETs are removed without too much surrounding tissue. In our experience, what is most important for complete resection is to keep the SET capsule intact during resection ( 4,5 ). Th erefore, a more practical and reasonable defi nition for complete resection of SETs by pathology is that a resected tumor has an intact capsule.…”

Section: Definition For Complete Resectionmentioning

confidence: 99%

Editorial: Endoscopic Resection of Upper Gastrointestinal Subepithelial Tumors: Promising New Endoscopic Techniques—Are They Here to Stay?

Cai

2016

American Journal of Gastroenterology

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Long-term Outcomes of Submucosal Tunneling Endoscopic Resection for Upper Gastrointestinal Submucosal Tumors

Cited by 121 publications

References 18 publications

Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria

Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria

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

Editorial: Endoscopic Resection of Upper Gastrointestinal Subepithelial Tumors: Promising New Endoscopic Techniques—Are They Here to Stay?

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