Endoscopy 2002; 34(1): 82-85
DOI: 10.1055/s-2002-19386
Original Article
© Georg Thieme Verlag Stuttgart · New York

Use of Endoscopic Ultrasound-Guided Injection in Endoscopic Resection of Solid Submucosal Tumors

S.  Sun1 , M.  Wang1 , S.  Sun1
  • 1Endoscopy Center, Second Clinical College of China Medical University, Shenyang, China
Further Information

Publication History

Submitted 21 November 2000

Accepted after Revision 19 July 2001

Publication Date:
14 August 2002 (online)

Aims: Submucosal tumor (SMT) is a common disease. We used endoscopic ultrasound (EUS)-guided puncture to inject saline before resection of SMTs, and evaluated the usefulness of this method.

Patients and Methods: We selected 16 symptomatic patients with solid SMTs in the upper gastrointestinal tract, confirmed by endoscopy and EUS. We first used EUS-guided puncture to inject saline to separate the submucosal lesions from the deeper normal tissues. Lesions in the muscularis mucosa and submucosa were then removed directly by snare cauterization. Lesions in the muscularis propria were treated by means of a two-step approach: first, we incised the superficial tissue of the tumors using an electrosurgical needle, and second, we enucleated SMTs as much as possible by tightening the snare around them and creating pseudo-stalks. After snare excision of SMTs, the cleavages of the superficial tissues were closed using metal clips.

Results: Among the 16 patients, one lesion was in the muscularis mucosa, six were in the submucosa, and nine were in muscularis propria. All the lesions were resected thoroughly. No perforation occurred nor had any recurrences been observed at follow-up of 12 - 17 months.

Conclusions: EUS-guided puncture to inject saline before resection is a safe and accurate procedure in the treatment of submucosal tumors.

References

  • 1 Postlewait R W. Benign tumors and cysts of the esophagus.  Surg Clin N Am. 1983;  63 925
  • 2 Morson B C, Dawson I MP. Nonepithelial tumors.  In: Frank P (ed) Gastrointestinal pathology. 2nd ed. Oxford; Blackwell Scientific 1979: 187-199
  • 3 van Stock R U. Subepithelial lesions. In: Van Dom J (ed) Gastrointestinal endosonography. 1st ed. W.B. Saunders 1999: 153
  • 4 Bjork J T. Nonepithelial neoplasms of the stomach.  Gastrointest Endosc. 1981;  23 162-163
  • 5 Watson D I, Game P A, Devitt P G. Laparoscopic resection of benign tumors of the posterior gastric wall.  Surg Endosc. 1996;  10 (5) 540-541
  • 6 Wolfsohn D M, Savides T J, Easter D W, Lyche K D. Laparoscopy-assisted endoscopic removal of a stromal-cell tumor of the stomach.  Endoscopy. 1997;  29 (7) 679-682
  • 7 Allam M E, Mehta D, Zelen J, Fogler R. Posterior wall gastric leiomyoma: endoscopic tattooing facilitates laparoscopic resection.  J Soc Laparoendosc Surg. 1998;  2 (1) 83-84
  • 8 Seelig M H, Hinder R A, Floch N R, et al. Endo-organ and laparoscopic management of gastric leiomyomas.  Surg Laparosc Endosc. 1999;  9 (1) 78-81
  • 9 Yamashita Y, Maekawa T, Sakai T, Shirakusa T. Transgastrostomal endoscopic surgery for early gastric carcinoma and submucosal tumor.  Surg Endosc. 1999;  13 (4) 361-364
  • 10 Hepworth C C, Menzies D, Motson R W. Minimally invasive surgery for posterior gastric stromal tumors.  Surg Endosc. 2000;  14 (4) 349-353
  • 11 Papazian A, Gineston J L, Capron J P, Quenum C. Leiomyoblastoma of the stomach: endoscopic treatment.  Endoscopy. 1984;  J16 (4) 157-159
  • 12 Crosta C, Meroni E, Alloni R, et al. Gastric submucosal neoplasms: new diagnostic and therapeutic procedures.  Ital J Surg Sci. 1987;  17 (2) 131-134
  • 13 Yu J P, Luo H S, Wang X Z. Endoscopic treatment of submucosal lesions of the gastrointestinal tract.  Endoscopy. 1992;  24 (3) 190-193
  • 14 Spinelli P, Cerrai F G, Cambareri A R, et al. Two-step endoscopic resection of gastric leiomyomas.  Surg Endosc. 1993;  7 (2) 90-92
  • 15 Binmoeller K F, Grimm H, Soehendra N. Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma.  Gastrointest Endosc. 1993;  39 (2) 172-174
  • 16 Vilmann P, Hancke S. Endoscopic ultrasound with guided needle biopsy and color Doppler examination in the upper gastrointestinal tract.  Endoscopy. 1992;  24 656
  • 17 Giovannini M, Seitz J F, Monges G, et al. Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177

S. Siyu, M.D.

Endoscopy Center · Second Clinical College of China Medical University

Shenyang · 110003 · China

Fax: + 86-024-23892617

Email: sunsiyu@ihw.com.cn