Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer

Abstract

Submucosal tunneling endoscopic resection appears to be a feasible, safe, and effective procedure for treatment of small (≤3 cm) upper GI SETs originating from the MP layer.

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

“…Thus, submucosal injection of different solutions (such as glicerol or hyaluronic acid) a cushion beneath the lesion is created, separating the mucosa from the muscularis propia and enabling the tumor excision through a endoscopic submucosal dissection (ESD) (16,32), which safely allows enucleation of lesions that arise in the muscularis mucosae and the muscularis propia layer up to 3 cm. Endoscopic submucosal tunnel dissection (ESTD) has also been recently described, showing similar results and a lower risk of complications (27,28). We do not have enough experience in this kind of procedures, but we think they could be an available management alternative for experienced groups and small tumors, according to the published results (Fig.…”

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

“…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).…”

“…Gas-associated complications are the most common complications of STER and may occur in ≤66.7% of patients undergoing STER (10). Those patients who undergo full-thickness resection exhibit an increased rate of gas-associated complications, though the majority of these are clinically insignificant and may resolve spontaneously (7,10,12,13,29). Thoracic drainage is recommended for pneumothorax in patients with lung collapse >30% and symptoms that include dyspnea, and lung puncture is recommended for patients with pneumoperitoneum or emphysema and more apparent symptoms (29).…”

“…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)(4)(5). Submucosal tunneling endoscopic resection (STER) has emerged as a novel technique for treating upper gastrointestinal SMTs and has yielded promising results (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(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.…”

Is a “wait-and-see” policy the best for small gastric gastrointestinal stromal tumor (GIST)?

“…It should be noted, however, that the authors selectively used endoscopic resection in patients with tumors exhibiting intraluminal growth, not in patients with extramural and mixed-type GISTs. Ye et al (5) have reported a higher risk of perforation in tumors located at…”