A Feasiblity Study Of Submucosal Tunneling Endoscopic Resection For The Treatment Of Esophageal Submucosal Tumors Originating From The Muscular Propria Layer

Background :A variety of benign mass lesions can arise from different wall layers in the esophagus. These tumors are usually asymptomatic and slow growing, noted only as incidental findings during routine radiography or endoscopy. The most common benign esophageal tumor is the leiomyoma.Endoscopic therapy has developed from the strip biopsy1 to direct resection with a snare to endoscopic mucosal resection(EMR). EMR has several disadvantages, however, including the high rates of residual tumor tissue and tumor recurrence.To date, several experimental studies have described the use of the submucosal tunneling technique for GI subepithelial lesions.Submucosal tunneling endoscopic resection(STER) has been proved to be safe and effective for removal of upper GI tumors originating from the muscularis propria(MP). Objectives :The objective was to evaluate the clinical value of submucosal tunneling endoscopic resection(STER) for the treatment of submucosal tumors(SMTs) originating from the muscular propria(MP) in Esophagus and comparing it to that of submucosal tumors(SMTs) originating from the muscular propria(MP) in Stomach. Design:A retrospective descriptive study conducted at a single center in China. Place and Duration of StudyEndoscopic center of First Hospital of Jilin University, Changchun, China from JAN 1, 2014 to JAN 1, 2016. Patients and MethodsTwenty-tow consecutive patients with single SMT originating from the MP layer in upper GI tract were treated by STER in Endoscopy Center and Endoscopy of Jilim first Hospital, Jilin University between JAN 1, 2014 to JAN 1, 2016. ResultsA total of 22 patients met the inclusion criteria during the study period.Of the 22 lesions, 12 were located in the gastric corpus close to the cardia, 3 in the gastric fundus close to the cardia, 6 in the lesser curvature of the gastric corpus, and 11 in the greater curvature of the gastric antrum.The mean age of the patients was 52.32 years(range, 35-68 years), and the male/female ratio was 1:1(11 male vs 11female). Complete resection rate was 82%(18/22). Eighteen lesions were resected en bloc.Pathological diagnosis of these tumors included leiomyoma(10 out of 22) and gastrointestinal stromal tumor(9 out of 22) ConclusionSTER allowed a high en bloc and complete resection rate, and considered to be flexible, the technique became widely acceptable.STER, as a novel endoscopic therapeutic resection technique, appears to be a feasible, safe and effective method for treating multiple SMTs originating from the MP layer in the esophagus.Applying STER technique for resecting esophageal SMTs originating from the MP layer could maintain the mucosa intact reduces infection and other complications occurrence due to perforation resulting from fullthickness resection.