Endoscopy 2020; 52(S 01): S135
DOI: 10.1055/s-0040-1704417
ESGE Days 2020 ePoster Podium presentations
Upper GI: Resection techniques 2 09:30 – 10:00 Thursday, April 23, 2020 ePoster Podium 6
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC RESECTION OF UPPER GASTROINTESTINAL SUBMUCOSAL TUMOURS: ESD, STER AND ETFR

H Awadie
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
,
S Gupta
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
2   The University of Sydney, Sydney, Australia
,
IB Yishay
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
,
J Yang
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
,
NG Burgess
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
2   The University of Sydney, Sydney, Australia
,
EYT Lee
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
,
V Kwan
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
,
MJ Bourke
1   Westmead Hospital, Gastroenterology and Hepatology Department, Westmead, Australia
2   The University of Sydney, Sydney, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Upper gastrointestinal submucosal tumours (U-SMTs) are infrequent but may contain malignant potential. Some may require removal for treatment and on occasion definitive diagnosis may necessitate complete excision. A range of techniques have been developed to facilitate endoscopic removal and avoid surgical resection, even for lesions involving the muscularis propria (MP). This includes endoscopic submucosal dissection (ESD), submucosal-tunnelling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR).

Methods We conducted a prospective observational study over 84 months until October 2019 (NCT-02306707). Procedure technique was guided by pre-resection endoscopic appearance, cross-sectional imaging and predicted MP involvement based on EUS. For each lesion, all resection techniques were available. Oesophageal lesions were planned for STER and gastric lesions for ESD or EFTR with endoscopic suture closure. Lesions >30mm were consented for possible laparoscopic gastrotomy for specimen retrieval by the surgical team.

Results 59 endoscopic resections for U-SMTs were performed (mean age 61±12, 57.6% male). Procedures included ESD (n=47), STER (n=7) and EFTR (n=5). Mean lesion size was 22±14mm. Pathology included leiomyoma (29.3%), neuroendocrine tumours (27.6%) and GISTs (12.1%). Median length of stay was 1 day (IQR 1-2). There were no adverse events.

Technical success for ESD was 87.2%. En-bloc resection was achieved in 97.6%. Involvement of the MP was identified in seven cases (14.9%). Six were deemed non-resectable intra-procedurally and were referred to surgery, with five located in the stomach (p=0.15). Two lesions resected by EFTR, of 40-50mm size, required laparoscopic gastrotomy for retrieval

Conclusions U-SMTs can be effectively treated with endoscopic resection. As extent of MP involvement may not be reliably appreciated by EUS, switch between endoscopic resection approaches should be considered intra-procedurally if required. Planned resection for lesions >30mm should involve a surgical team for consideration of laparoscopic gastrotomy to retrieve the specimen, as this still allows for organ preservation