The Application Modified Endoscopic Submucosal Excavation In The Treatment Of Submucosal Tumors

Endoscopic submucosal excavation (ESE) is a widely used treatment forsubmucocal lesions in gastrointestinal tract.The aim of our study is to explore someoperational thinking and Operating skills derive in ESE, and evaluate the effect of theseskills on the treatment of gastrointestinal submucocal tumors. In hopes of providingsome constructive opinions for the development of ESE technique in china.Methods: From September2009to December2012, patients underwent revisedESE characterized by blunt separation skills such as direct push, squeeze and negativepressure suction with a cap, thinking of not controlling minimal bleeding, making use ofthe weight of tumors, selection of the first cut at the inconvenient place in the FirstAffiliated Hospital of Dalian Medical University were included in our retrospectivestudy, we analyzed the patient’s clinical and lesion related endoscopic manifestations,postoperative complications and pathologic data. The following factors were recordedand statistically analysed:(1) Patients factors： gender, age, smoking, drinking,clinical symptoms, CEA, existence of hypertension, diabetes mellitus and otherchronic diseases;(2) Lesions factors：tumor size, location, depth, gross morphology,pathological types;(3) Effect of revised ESE: status of completeresection, intraoperative and postoperative complications. Of the78patients who wereincluded in the study, ESE were successfully performed in72and failed in6of which3were caused by poor elevation of the lesion and surgical treatment was performedafterwards；2were caused by hemorrhage during operation and poor effect ofhemostasis;1caused by intraoperative perforation, wounds were closed by hemostaticclips, symptoms of abdominal pain and pyrexia persisted for10days and, therefore,surgical treatment was performed. Complete resection was achieved in68cases; theoperating skills mentioned above were applied in53cases.7patients had delayedbleeding. In6cases, delayed bleeding occurred within24hours after ESE with signs of drainage of bloody fluid from nasogastric tube. All were stopped after Endoscopiccontrol of hemorrhage such as usage of hemostatic clips and Fibrin glue sprinkle,Postoperative ambrosia and venous transfusion. Intraoperative perforation occurred in3cases, all arising from muscularis propria, which were successfully repaired by theapplication of clips, the symptoms of abdominal pain and pyrexia disappeared beforethe10th day after treatment, and intra-abdominal gas were found much reduced underCT scanning. Modified ESE required much less operative time.Conclusion: Skillful application of blunt separation skills such as Direct Push,squeeze and negative pressure suction with a cap, thinking of not controlling minimalbleeding, making use of the weight of tumors, selection of the first cut at theinconvenient place will make remarkable contribution in shortening operative time.Comparing with traditional ESE modified ESE Shows no difference in occurrence ofpostoperative complications when complete resection is achieved.