The Safety And Efficiency Of Endoscopic Resection For Submucosal Tumors In The Esophagogastric Junction

Obejective:To evaluate the safety and efficiency of endoscopic dissection technique for submucosal tumors (SMTs) in the esophagogastric junction (EGJ).Methods:A total of43cases of SMTs in the EGJ were treated by endoscopic resection in the Endoscopy Center of the First Affiliated Hospital, College of Medicine, Zhejiang University between January2010and October2013. All patients were confirmed by EUS and upper abdominal CT. The EUS image, surgical approach, en bloc resection rate, clinical and histopathologic feature, complications, and postoperative follow up were evaluated. Compared ESD-based endoscopic resection technique in the treatment for SMTs of EGJ with other upper gastrointestinal in the same period, to evaluate whether various endoscopic resection method ESD-based is safe or effective procedure for SMTs in the EGJ.Results:In43cases of SMTs in the EGJ, there were19males and24females with a mean age of (52.0±11.0) years old.32cases accepted ESD or ESE treatment and11patients received STER treatment. The en bloc resection rate was100%.The mean lesion size was (27.81±19.51) mm. The mean procedure time was (66.97±30.53) minutes and the mean bleeding volume during operation was (4.65±12.12)ml. No patient developed bleeding after endoscopic dissection. Compared ESD/ESE with STER in age, operation time, lesion size, bleeding volume during operation and hospitalized days, there was no statistical difference(P>0.05). Perforations occurred in4patients, Pneumoperitonium in2patients, esophago-mediastinal fistula in1patient, all of them were successfully managed with conservational therapy, and1patient with severe pneumothorax was treated with surgery. No serious complications such as secondary abdominal cavity infection and postoperative gastrointestinal stenosis appeared. Pathological examination showed that the lesions were leiomyoma(n=19), gastrointestinal stromal tumor(n=14), unknown pathological type of spindle cell tumor(n=5) and intermuscular lipoma(n=3), mutinous cystadenoma(n=1). The coincidence rate of originating layer between EUS and pathological diagnosis was100%. Compared EGJ with other upper gastrointestinal in age, operation time, lesion size, bleeding volume during operation and hospitalized days, there was no statistical difference(P>0.05). No local recurrence and distant metastasis were noted during the follow-up.Conclusion:Various endoscopic resection method based endoscopic submucosal dissection is both safe and effective procedure for SMTs in the EGJ.