Abstract
Background and study aims The histologic diagnosis of submucosal tumors (SMTs) < 20 mm is challenging. Monitoring
is the main option offered, but compliance is debatable. Endoscopic resection (ER)
of malignant SMTs or those with an uncertain diagnosis is an alternative that has
already been reported about and proposed in our center. The aims of this study were
to confirm the safety of this resection strategy and to perform long-term follow-up
of malignant SMTs after resection.
Patients and methods All patients who underwent ER for SMTs < 2 cm in a single center between 2007 and
2019 were included retrospectively. Patients were classified into two groups according
to the need for postresection follow-up: benign SMTs (B-SMTs) and follow-up SMTs (FU-SMTs).
Results One hundred and one patients were included. The mean tumor size was 16.7 mm. In total,
92 of 101 SMTs had an uncertain diagnosis. Macroscopic resection was completed for
95 SMTs (93.1 %), with en bloc resection in 94 (92.1%). The morbidity rate was 3 %,
with no mortality. A total of 84 of 101 SMTs (84 %) were B-SMTs and did not need monitoring,
and 17 SMTs (19.7 %) were FU-SMTs (8 gastrointestinal stromal tumors, 6 neuroendocrine
tumors, and 3 others). No relapse was reported in the FU-SMT group, with a median
follow-up duration of 33 months [4–127] (61 months [17–127] for the gastrointestinal
stroma tumor group).
Conclusions The study results suggest ER is a potentially reliable and effective strategy for
upper gastrointestinal tract SMTs < 20 mm. Although the strategy needs further validation
in advanced care units, it could eliminate the need for long-term monitoring, therefore
targeting such follow-up efforts to patients with FU-SMTs.
