Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia

Abstract

tEMD appears to be a feasible minimally invasive and effective treatment for patients with SETs originating from the MP layer of the esophagus and cardia.

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

“…Complete resection without damaging the tumor capsule is recommended. For SMTs originating from the deep MP layer or exhibiting a tight connection with the underlying MP or serosal layers, a full-thickness resection, including the lesion, its underlying MP and serosa is generally performed (10,15,32). For patients with gastric SMTs undergoing full-thickness resection, the SMT should be prevented from lodging in the * Gastric corpus or fundus proximate to the cardia, the lesser curvature of the gastric corpus and the greater curvature of the gastric antrum.…”

“…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).…”

“…Mucosal lacerations may occasionally occur and the majority are small (<1 cm) and may be closed using ≥1 clip. In the aforementioned >20 studies, mucosal laceration occurred in a total of 15 patients and in each case the laceration was closed using clips without leakage (10,15,16,18,19,29). Two case reports have reported on large esophageal mucosal lacerations, which were managed using stent insertions (26,28).…”

“…Gas-associated complications include subcutaneous emphysema, pneumothorax, pneumoperitoneum, and mediastinal emphysema. 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).…”

“…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.…”