Resection of subepithelial gastrointestinal tumors by means of endoscopic surgery (ESD, STER, NOTES, LECS). A single center experience

Aims Retrospective study of endosurgical resection of subepithelial tumors of the GI tract by means of endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER), laparoscopic endoscopic cooperative surgery (LECS), natural orifice transluminal endoscopic surgery (NOTES) in a non-academic private hospital in Greece by a single operator between 2016-2023, with extensive experience in ESD and third space endoscopy.

Methods 30 lesions were resected from 27 patients from the esophagus, stomach, duodenum and colon and rectum by ESD (24), STER (4), LECS (1), NOTES (1). The median age was 56.5 (36-81). Indications for resection were: 1) diagnosis of GIST or NET, 2) origin from the muscle layer without biopsy, 3) increasing size in follow-up, 4) obstruction, 5) patient’s desire to avoid chronic follow-up. CT scan and/or EUS were performed for lesions>1 cm. Poorly submucosal lesion were resected by means of ESD. Lesions originating from the muscle layer were resected by means of STER if tunneling was feasible. LECS was applied in one gastric case of the anterior gastric wall where the muscular defect could not be closed with clips. NOTES was applied for a gastric GIST of the posterior wall of the body and the defect was closed with loop and clips.

Results The median operation duration was 1.2 hours (0,5-4) and the median duration of hospitalization was 1 day (1-3). No complication was encountered. 2 patients presented with mild epigastric pain after LECS and NOTES. The median tumor size was 2.2 cms (0.6-7). Histology showed: GIST (4), leiomyoma (1), schwannoma (1), abrikossof (4), neuroendocrine tumor (7), fibroid inflammatory polyps (2), ectopic pancreas (2), lipoma (9).

Conclusions Endoscopic resection of gastrointestinal subepithelial tumors is feasible and safe by means of different endosurgical procedures based on the location and operator’s experience

Publication History

Article published online:
15 April 2024