Endoscopy
DOI: 10.1055/a-2369-7854
Original article

A Sub-epithelial Lesion Algorithm For Endoscopic (SAFE) Resection In The Upper Gastrointestinal Tract

1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, University of Sydney, Sydney, Australia
,
Julia Gauci
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
Timothy O'Sullivan
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, University of Sydney, Sydney, Australia
,
Oliver Cronin
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, University of Sydney, Sydney, Australia
,
Anthony Whitfield
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, University of Sydney, Sydney, Australia
,
Ana Craciun
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
Jing Yang
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
Vu Kwan
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
Eric Yong Tat Lee
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, University of Sydney, Sydney, Australia
,
Michael J. Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Department of Medicine, University of Sydney, Sydney, Australia
› Author Affiliations

Introduction: Complete excision of upper gastrointestinal sub-epithelial lesions (U-SELs) eliminates diagnostic uncertainty, obviates the need for surveillance and may be necessary for definitive diagnosis and management. Current guidelines lack precision and cohesion, and surgery is associated with significant morbidity. Herein, we describe and report on the outcomes of our SEL algorithm for endoscopic (SAFE) resection. Methods: U-SELs were enrolled prospectively over 115 months until March 2023. All underwent axial (CT) imaging and endoscopic-ultrasonography (EUS) to exclude a large exophytic component or invasion into local structures, and assess for muscularis propria involvement. Results: 106 U-SELs were resected (mean age 60.6±13.4, 51.9% male; 41 oesophageal, 65 gastric). Oesophageal U-SELs underwent ESD (n=22) or STER if MP involvement was suspected (n=19). Gastric U-SELs underwent STER (n=6 at cardia), ESD (n=47) or exposing-EFTR (n=12). Technical success was 97.6% and 92.3% respectively. Five (7.7%) were completed laparoscopically due to deep and broad full-thickness involvement. Five (7.7%) required laparoscopic gastrotomy and surgical retrieval after successful resection and closure due to a large lesion size (mean 47 mm). There was no delayed bleeding, perforation or recurrence at 13 months. Conclusion: U-SELs may be effectively and safely treated by endoscopic resection. The SAFE approach provides a framework that facilitates structured decision-making. Oesophageal U-SELs suspected to involve the MP should undergo STER. Gastric SELs can be best managed by ESD with a view to proceed to exposing-EFTR. A laparoscopic UGI surgeon should be available in case surgical retrieval of the specimen or laparoscopic completion is required.



Publication History

Received: 23 August 2023

Accepted after revision: 19 July 2024

Accepted Manuscript online:
19 July 2024

© . Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany