Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2019; 25(2): 245-257
Published online Jan 14, 2019. doi: 10.3748/wjg.v25.i2.245
Submucosal tunneling endoscopic resection: An effective and safe therapy for upper gastrointestinal submucosal tumors originating from the muscularis propria layer
Chen Du, Ning-Li Chai, En-Qiang Ling-Hu, Zhen-Juan Li, Long-Song Li, Jia-Le Zou, Lei Jiang, Zhong-Sheng Lu, Jiang-Yun Meng, Ping Tang
Chen Du, Ning-Li Chai, En-Qiang Ling-Hu, Zhen-Juan Li, Long-Song Li, Jia-Le Zou, Lei Jiang, Zhong-Sheng Lu, Jiang-Yun Meng, Ping Tang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Du C, Chai NL, and Ling-Hu EQ designed the study; Chai NL, Ling-Hu EQ, Lu ZS, Meng JY, and Tang P performed the research; Du C, Li ZJ, Li LS, Zou JL, and Jiang L contributed new reagents or analytic tools; Du C and Li ZJ analysed the data; Du C wrote the paper; Chai NL and Ling-Hu EQ made critical revisions to the article for important intellectual content; all authors approved the final article; Du C and Chai NL contributed equally to this manuscript.
Supported by the National Program on Key Research Project (13-5 Program), No. 2016YFC1303601; and Chinese PLA General Hospital Clinical Research, No. 2012FC-TSYS-3035.
Institutional review board statement: The clinical trial of this paper was reviewed and approved by the Committee of Medical Ethics of Chinese PLA General Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: En-Qiang Ling-Hu, MD, PhD, Professor, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Telephone: +86-10-68182255 Fax: +86-10-68154653
Received: September 27, 2018
Peer-review started: September 27, 2018
First decision: October 23, 2018
Revised: November 19, 2018
Accepted: December 19, 2018
Article in press: December 19, 2018
Published online: January 14, 2019
Abstract
AIM

To evaluate the effectiveness and safety of submucosal tunneling endoscopic resection (STER) and compare its outcomes in esophageal and cardial submucosal tumors (SMTs) of the muscularis propria (MP) layer.

METHODS

From May 2012 to November 2017, 173 consecutive patients with upper gastrointestinal (GI) SMTs of the MP layer underwent STER. Overall, 165 patients were included, and 8 were excluded. The baseline characteristics of the patients and SMTs were recorded. The en bloc resection rate, complete resection rate, residual rate, and recurrence rate were calculated to evaluate the effectiveness of STER, and the complication rate was recorded to evaluate its safety. Effectiveness and safety outcomes were compared between esophageal and cardial SMTs.

RESULTS

One hundred and twelve men and 53 women with a mean age of 46.9 ± 10.8 years were included. The mean tumor size was 22.6 ± 13.6 mm. Eleven SMTs were located in the upper esophagus (6.7%), 49 in the middle esophagus (29.7%), 46 in the lower esophagus (27.9%), and 59 in the cardia (35.7%). Irregular lesions accounted for 48.5% of all lesions. STER achieved an en bloc resection rate of 78.7% (128/165) for GI SMTs with an overall complication rate of 21.2% (35/165). All complications resolved without intervention or were treated conservatively without the need for surgery. The en bloc resection rates of esophageal and cardial SMTs were 81.1% (86/106) and 72.1% (42/59), respectively (P = 0.142), and the complication rates were 19.8% (21/106) and 23.7% (14/59), respectively, (P = 0.555). The most common complications for esophageal SMTs were gas-related complications and fever, while mucosal injury was the most common for cardial SMTs.

CONCLUSION

STER is an effective and safe therapy for GI SMTs of the MP layer. Its effectiveness and safety are comparable between SMTs of the esophagus and cardia.

Keywords: Endoscopic resection, Submucosal tunnel, Submucosal tumor, Muscularis propria layer, Esophagus, Cardia

Core tip: Submucosal tunneling endoscopic resection (STER) was initially reported in 2012 for the resection of submucosal tumors (SMTs) originating from the muscularis propria. It has an advantage in maintaining the integrity of the mucosa. Several studies have demonstrated the effectiveness and safety of STER; however; few studies have enrolled large populations over 100 cases and compared the effectiveness and safety of STER for SMTs located in different locations. In this study, we aimed to further evaluate the effectiveness and safety of STER for gastrointestinal SMTs in a large population and compare the feasibility of STER for resection of esophageal and cardial SMTs.