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Endoscopy 2018; 50(01): 85
DOI: 10.1055/s-0043-123579
Letter to the editor
© Georg Thieme Verlag KG Stuttgart · New York

Reply to Li & Linghu

Qiang Zhang
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
,
Jian-Qun Cai
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
,
Zhen Wang
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
,
Yue-Xin Ren
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
,
Yang Bai
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
› Author Affiliations
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Publication History

Publication Date:
21 December 2017 (online)

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Does the double-opening submucosal tunneling endoscopic resection technique really work for submucosal tumors in the esophagus and gastric fundus near the cardia?Endoscopy 2018; 50(01): 84-84
DOI: 10.1055/s-0043-122388

We appreciate the comments by Li & Linghu and their interest in our recent study regarding modified submucosal tunneling endoscopic resection (STER) for submucosal tumors in the esophagus and gastric fundus near the cardia – the double-opening (DO-STER) technique [1].

In this study, as a preliminary, we set the inclusion criteria by reviewing 10 cases in which DO-STER was performed. These inclusion criteria focused on two key points: tumor size and tumor location. For large submucosal tumors in the esophagus, limited tunnel space may lead to greater difficulty in resecting the tumor and DO-STER may considered as an alternative in such cases. In addition, for tumors at the esophagogastric junction (EGJ) and the gastric fundus near cardia where endoscopic operation may be relatively difficult, performance of DO-STER may reduce the difficulty of the endoscopic procedure, especially for tumors in these sites that are also large in size. In our research, three relatively small submucosal tumors were all located either at the EGJ or the gastric fundus near the cardia, and met the inclusion criteria because of their location. The decision to use DO-STER in these three cases was based on our judgment, and this approach may or may not be warranted in other settings. However, because of the anatomical constraints, such a concern is legitimate in our view. Whether DO-STER indeed offers a clear advantage over standard STER in such cases remains to be investigated.

Our study included 10 cases, one of which was a piecemeal resection, resulting in an en bloc resection rate of 90 %. This tumor was located at the EGJ. During the resection, massive intraoperative bleeding occurred, and the decision not to perform en bloc resection was based on the need to identify the bleeding source using an endoscopic snare rather than space limitation of the tunnel.

For further improvement, studies with large sample sizes are necessary to compare the en bloc resection rate of DO-STER with those of other procedures, and to clarify the boundaries of its potential use.

 

  • Reference

  • 1 Qiang Zhang, Jian-Qun Cai, Li Xiang. et al. Modified submucosal tunneling endoscopic resection for submucosal tumors in the esophagus and gastric fundus near the cardia. Endoscopy 2017; 49: 784-791
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