Modified submucosal tunneling endoscopic resection for submucosal tumors in the esophagus and gastric fundus near the cardia

Abstract

Background and study aims Submucosal tunneling endoscopic resection with double opening (DO-STER) was developed by our group for the resection of submucosal tumors in the esophagus and gastric fundus near the cardia. This study aimed to provide a preliminary evaluation of feasibility and safety of DO-STER.

Methods The key to DO-STER is the creation of a tunnel opening in the mucosa over the inferior border of the tumor. During resection, the tumor can be gradually pushed out of the submucosal tunnel through the opening, leaving enough space for operation within the tunnel. A total of 10 tumors resected by DO-STER were retrospectively reviewed.

Results All tumors were successfully resected by DO-STER. One tumor was located at the lower esophagus, four at the esophagogastric junction, and five at the gastric fundus near the cardia. Tumor size ranged from 1.0 × 1.2 cm to 3.5 × 5.0 cm, and all tumors originated from the muscularis propria. Operative times ranged from 45 to 150 minutes. No delayed bleeding or perforation occurred.

Conclusion DO-STER seems to provide an alternative approach for resection of tumors in the esophagus and gastric fundus near the cardia.

^* These authors contributed equally to the study.

• References

• 1 Nishida T, Blay JY, Hirota S. et al. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines. Gastric Cancer 2016; 19: 3-14
• 2 Kushnir VM, Keswani RN, Hollander TG. et al. Compliance with surveillance recommendations for foregut subepithelial tumors is poor: results of a prospective multicenter study. Gastrointest Endosc 2015; 81: 1378-1384
• 3 Hwang JH, Rulyak SD, Kimmey MB. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 2006; 130: 2217-2228
• 4 Lv XH, Wang CH, Xie Y. et al. Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors: a systematic review and meta-analysis. Surg Endosc 2016; 31: 49-63
• 5 Chen T, Zhou PH, Chu Y. et al. Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg 2017; 265: 363-369
• 6 Li QY, Meng Y, Xu YY. et al. Comparison of endoscopic submucosal tunneling dissection and thoracoscopic enucleation for the treatment of esophageal submucosal tumors. Gastrointest Endosc 2016; DOI: 10.1016/j.gie.2016.11.023.
• 7 Tan Y, Lv L, Duan T. et al. Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer. Surg Endosc 2016; 30: 3121-3127
• 8 Werner YB, Rösch T. POEM and submucosal tunneling. Curr Treat Options Gastro 2016; 14: 163-177
• 9 Xu MD, Cai MY, Zhou PH. et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 2012; 75: 195-199
• 10 Inoue H, Ikeda H, Hosoya T. et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012; 44: 225-230
• 11 Abe N, Takeuchi H, Ooki A. et al. Recent developments in gastric endoscopic submucosal dissection: towards the era of endoscopic resection of layers deeper than the submucosa. Dig Endosc 2013; 25: 64-70
• 12 Li QL, Zhou PH, Xu MD. et al. Offshoots of peroral endoscopic myotomy: submucosal tunneling endoscopic resection, pyloromyotomy, and beyond. Tech Gastrointest Endosc 2013; 15: 160-163
• 13 Quan-Lin Li, Wei-Feng Chen, Chen Zhang. et al. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc 2015; 29: 3640-3646
• 14 Zhou DJ, Dai ZB, Wells MM. et al. Submucosal tunneling and endoscopic resection of submucosal tumors at the esophagogastric junction. World J Gastroenterol 2015; 21: 578-583
• 15 Li B, Liu J, Lu Y. et al. Submucosal tunneling endoscopic resection for tumors of the esophagogastric junction. Minim Invasive Ther Allied Technol 2016; 25: 141-147
• 16 Ng JJ, Chiu PWY, Shabbir A. et al. Removal of a large, 40-mm, submucosal leiomyoma using submucosal tunneling endoscopic resection and extraction of specimen using a distal mucosal incision. Endoscopy 2015; 47: E232-E233
• 17 Tan Y, Zhu H, Lv L. et al. Enlarging an accidental mucosotomy to facilitate tumor extraction during submucosal tunneling endoscopic resection for a giant esophageal leiomyoma. Gastrointest Endosc 2016; 83: 248-249
• 18 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