Efficiency And Safety Of Endoscopic Submucosal Excavation In The Treatment Of Submucosal Tumors Of The Stomach

Background and Objective Submucosal tumors(SMTs)of the stomach were occasionally found during endoscopy procedure.Some submucosal tumors were potentially malignant,but there were not clear treatment criteria for the submucosal tumors.Ultrasound endoscopy had limitations for the diagnosis of tumors.There was a lack of the research about the treatment of gastric submucosal tumors with Endoscopic Submucosal Excavation(ESE).The effectiveness and safety of ESE was still not very clear.To provided a theoretical basis for endoscopic treatment of submucosal tumors.Methods We retrospectively analyzed the clinical data of the patients with the gastric submucosal tumor originating from the muscularis propria diagnosed by gastroscopy and endoscopic ultrasonography and resected by ESE during the period from February 2012 to June 2017.During the operation,the complications and the Strategies for the complications were mainly observed.The resection specimens were routinely performed histopathology and immunohistochemistry.And patients undergo regular gastroscopy and endoscopic ultrasonography for follow-up.Clinical data were analyzed about the clinical features of gastric SMTs with ESE in our hospital.We analyzed the statistical description of the patients’ age,gender,gastroscopy and endoscopic size of the tumors,tumor location and pathological types.Complete resection rate,en bloc resection rate,complications rate,average length of stay and median follow-up time were analyzed for the risk factors.The risk factors of incomplete resection and perforation were analyzed.Propose the improved measures to achieve complete resection,avoid perforation and deal with perforation.The patients were followed up by gastroscopy or ultrasound gastroscopy to observe the healing of the operation site,residual lesions and recurrences of local lesions.Final reached a conclusion.Results The median age of the patient was 52 years old.The male/female ratio was 97/43.The mean tumor size estimated by endoscopy was 13.7±7.2 mm,and the mean tumor size measured by endoscopic ultrasonography was 12.6±6.8mm.42.1% of the lesions were located in the stomach,42.1% in the fundus,10.0% in the antrum,5.0% in the cardia,and 1 in the antrum.Of the 140 patients,131(93.6%)were successfully and completely resected and 9(6.4%)were not completely resected.Of the 9 patients who had not been completely resected,4 had failed to undergo resection and were surgically treated.3 patients had tumor cells on one side of the surgical margin,and 2 had incomplete tumor capsules and did not achieve en bloc resection.The mean operation time was 46.6 ± 27.4minutes,and the median operation time was 38.5 minutes.Postoperative pathology was 52.9% for stromal tumors,37.1% for leiomyomas,9.3% for ectopic pancreas,and 1 for fat hemangioma.The incidence of complications was 16.4%(23/140).Nine patients(6.4%)had perforation during the operation.One case(0.7%)had delayed bleeding on the second postoperative day,7 cases(5%)had postoperative fever,and 5 cases(3.6%)had slight postoperative abdominal pain and mild tenderness in the abdomen.All cases had no pneumoperitoneum during the operation and no postoperative abscess complications occurred.The average length of hospital stay after surgery was 6±2days.In this study,each patient had a gastroscope follow-up,the median follow-up time was 11 months,and there was no residual tumor and local recurrence during follow-up after ESE resection.Conclusion Endoscopic submucosal extirpation was safe and effective in the treatment of <30mm gastric submucosal tumors derived from the muscularis propria.Tumor size was an independent risk factor for the inability of ESE to completely remove the tumor.Postoperative pathological type was an independent risk factor for intraoperative perforation.