Submucosal tunneling endoscopic resection of large submucosal tumors originating from the muscularis propria layer in the esophagus and gastric cardia^[*]

Abstract

Aims The aim of this study was to evaluate the short-term complications of submucosal tunneling endoscopic resection (STER) for large submucosal tumors (SMTs) originating from the muscularis propria (MP) layer in the esophagus and gastric cardia.

Methods We performed 286 cases of STER from September 2012 to December 2017. The clinical data of patients with SMTs originating from the MP layer of 3.0–7.0 cm, who underwent STER procedure at the endoscopy center of Tianjin Medical University General Hospital, were collected retrospectively. Epidemiological data, tumor location, tumor size, procedure-related parameters, complications, and follow-up were included.

Results A total of 27 (9.4 % [27/286]) patients were large-size SMTs, with a mean age of 51.9 ± 9.4 years. The male/female ratio was 19:8. Of the 27 SMTs, 23 were located in the esophagus and 4 in the gastric cardia. The mean tumor size was 4.0 ± 1.1 cm. The en bloc resection rate was 85.2 % (23/27), and the complete resection rate was 100 % (27/27). Intra-operative perforation occurred in 2 patients (7.4 %) and post-operative perforation occurred in 2 patients (7.4 %). No other complications were observed. The average cost of the procedure was $3357.99 ± $1171.60 per inpatient stay (including both the procedure and an additional inpatient stay). The mean follow-up time was 15 ± 10.1 months. No recurrence and metastasis occurred during the follow-up period.

Conclusions There is low risk of STER for the large-sized SMTs in the esophagus and gastric cardia, and the most common complication occurred during or after the procedure is perforation.

Zusammenfassung

Ziele Evaluierung der Frühkomplikationen einer STER bei großen SMTs der Tunica muscularis im Ösophagus und der Kardia.

Methoden Zwischen September 2012 und Dezember 2017 führten wir 286 STER-Eingriffe durch. Die klinischen Daten von Patienten mit SMTs, die aus der MP-Schicht von 3,0–7,0 cm stammen und im Endoskopiezentrum des Tianjin Medical University General Hospital im STER-Verfahren behandelt wurden, wurden retrospektiv erhoben. Epidemiologische Daten, Tumorlage, Tumorgröße, verfahrenstechnische Parameter, Komplikationen und Nachsorge wurden berücksichtigt.

Ergebnisse Bei insgesamt 27 (9,4 %; 27/286) Patienten handelte es sich um große SMTs; das Durchschnittsalter betrug 51,9 ± 9,4 Jahre. Das Verhältnis Männer/Frauen betrug 19:8. Von den 27 SMTs waren 23 im Ösophagus und 4 in der Kardia lokalisiert. Die Tumorgröße betrug durchschnittlich 4,0 ± 1,1 cm. Die Ratio der En-Bloc-Resektion betrug 85,2 % (23/27), die der vollständigen Resektion betrug 100 % (27/27). Bei zwei Patienten (7,4 %) kam es zu einer intraoperativen Perforation; eine postoperative Perforation trat bei zwei Patienten (7,4 %) auf. Es wurden keine weiteren Komplikationen beobachtet. Die Kosten für den Eingriff betrugen durchschnittlich 3357,99 ± 1171,60 $ für den stationären Aufenthalt (Eingriff und stationärer Aufenthalt). Eine Nachuntersuchung wurde nach durchschnittlich 15 ± 10,1 Monaten durchgeführt. In der Zeit bis zur Nachuntersuchung traten weder Rezidive noch Metastasen auf.

Schlussfolgerung Die Submukosale endoskopische Tunnelresektion (STER) bei großen submukösen Tumoren (SMTs) der Tunica muscularis im Ösophagus und der Kardia ist mit einem geringen Risiko verbunden. Die häufigste Komplikation während oder nach dem Eingriff ist eine Perforation.

Key words

large submucosal tumors - esophagus - gastric cardia - submucosal tunneling endoscopic resection

Schlüsselwörter

große submuköse Tumoren - Ösophagus - Kardia des Magens - Submukosale endoskopische Tunnelresektion

^* Author contributions: Zelan Wang and Zhongqing Zheng contributed equally to the manuscript. Tao Wang, Yuming Wang, Zhongqing Zheng, and Bangmao Wang designed the study. Xin Wang and Yanan Cao contributed essential statistical analysis. Zelan Wang and Zhongqing Zheng collected the clinical data. The financial arrangement was supported by Yuming Wang. The final version of this article was professionally edited by Bangmao Wang.

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