Endoscopic mucosa-sparing lateral dissection for treatment of gastric submucosal tumors: a prospective cohort study

Abstract

Background In our previous work, we developed a modified method for the removal of gastric submucosal tumors (SMTs), called endoscopic mucosa-sparing lateral dissection (EMSLD). This prospective study aimed to evaluate the efficacy and postoperative outcomes of EMSLD.

Methods We prospectively enrolled 25 consecutive patients with gastric SMTs, who received EMSLD treatment. Clinicopathological characteristics and operation-related outcomes were analyzed.

Results The mean age of patients was 49.3 ± 9.7 years, and the mean tumor size was 14.6 ± 6.1 mm. En bloc resection was achieved in all cases. The mean procedure time was 47.3 ± 25.9 minutes, and the estimated blood loss was 4.8 ± 3.5 mL. Endoscopic full-thickness resection was performed in six patients (24 %) because the tumors originated from the deep muscularis propria layer. All perforations and resection defects were successfully closed by the retained mucosa and endoclips. No serious complications related to EMSLD were encountered during or after the procedure.

Conclusions EMSLD was reliable and effective for the removal of gastric SMTs. However, large-scale randomized controlled trials are needed.

^* These authors contributed equally to this work.

• References

• 1 Bialek A, Wiechowska-Kozlowska A, Pertkiewicz J. et al. Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc 2012; 75: 276-286
• 2 Bang CS, Baik GH, Shin IS. et al. Endoscopic submucosal dissection of gastric subepithelial tumors: a systematic review and meta-analysis. Korean J Intern Med 2016; 31: 860-871
• 3 Meng Y, Li W, Han L. et al. Long-term outcomes of endoscopic submucosal dissection versus laparoscopic resection for gastric stromal tumors less than 2 cm. J Gastroenterol Hepatol 2017; 32: 1693-1697
• 4 Ye LP, Zhang Y, Luo DH. et al. Safety of endoscopic resection for upper gastrointestinal subepithelial tumors originating from the muscularis propria layer: an analysis of 733 tumors. Am J Gastroenterol 2016; 111: 788-796
• 5 Zhang Q, Li Y, Meng Y. et al. Should the integrity of mucosa be considered in endoscopic resection of gastric submucosal tumors?. Gastroenterology 2016; 150: 822-824
• 6 Zhang Q, Li Y, Lian ZY. et al. A modified endoscopic method for resection of gastric submucosal tumor. Surg Endosc 2018; 32: 536-543
• 7 Yang J, Feng F, Li M. et al. Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors. World J Surg Oncol 2013; 11: 273
• 8 Chun SY, Kim KO, Park DS. et al. Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: a preliminary analysis of appropriate indications. Surg Endosc 2013; 27: 3271-3279
• 9 Catalano F, Rodella L, Lombardo F. et al. Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study. Gastric Cancer 2013; 16: 563-570
• 10 Joo MK, Park JJ, Kim H. et al. Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract. Gastrointest Endosc 2016; 83: 318-326
• 11 Otake Y, Saito Y, Sakamoto T. et al. New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video). Gastrointest Endosc 2012; 75: 663-667