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CC BY 4.0 · Endosc Int Open 2024; 12(07): E868-E874
DOI: 10.1055/a-2325-3747
Original article

Endoscopic resection in subepithelial lesions of the upper gastrointestinal tract: Experience at a tertiary referral hospital in The Netherlands

Cynthia Verloop 
1   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
2   Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands (Ringgold ID: RIN7000)
,
Lieke Hol
2   Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands (Ringgold ID: RIN7000)
,
Marco Bruno
1   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Lydi Van Driel
1   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Arjun Dave Koch
1   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands (Ringgold ID: RIN6993)
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Abstract

Background and study aims Histological confirmation of subepithelial lesions (SELs) in the upper gastrointestinal tract remains challenging. Endoscopic resection of SELs is increasingly used for its excellent diagnostic yield and opportunity to do away with continued surveillance. In this study, we aimed to evaluate the indications, success rates and complications of different endoscopic resection techniques for SELs at a large, tertiary referral hospital in Rotterdam, The Netherlands.

Patients and methods Data between October 2013 and December 2021 were retrospectively collected and analyzed. Main outcomes were R0-resection rate, en bloc resection rate, recurrence rate, and procedure-related adverse events (AEs) (Clavien-Dindo). Secondary outcomes were procedure time, need for surgical intervention, and clinical impact on patient management.

Results A total of 58 patients were referred for endoscopic resection of upper gastrointestinal SELs. The median diameter of lesions was 20 mm (range 7–100 mm). Median follow-up time was 5 months (range 0.4–75.7). Forty-eight procedures (83%) were completed successfully leading to en bloc resection in 85% and R0-resection in 63%. Procedure-related AEs occurred in six patients (13%). Severe complications (CD grade 3a) were seen in three patients. The local recurrence rate for (pre)malignant diagnosis was 2%. Additional surgical intervention was needed in seven patients (15%). A total of 32 patients (67%) could be discharged from further surveillance after endoscopic resection.

Conclusions Endoscopic resection is a safe and effective treatment for SELs and offers valuable information about undetermined SELs for which repeated sampling attempts have failed to provide adequate tissue for diagnosis.

Keywords

Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Endoscopic ultrasonography - Subepithelial lesions - Tissue diagnosis

Supplementary Material



Publication History

Received: 25 September 2023

Accepted after revision: 03 May 2024

Accepted Manuscript online:
13 May 2024

Article published online:
10 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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