Management of gastrointestinal subepithelial tumors with endoscopic resection

摘要

The diagnosis and management of gastrointestinal subepithelial tumors (GI SETs) have been under debate because of the low biopsy yield rate and risk of surgery. Owing to the advancement in endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER), GI SETs may be resected under acceptable risk, and the nature of GI SETs can be studied. However, the efficacy of endoscopic resection in the diagnosis and management of GI SETs remains unclear. We present our single-hospital experience of resecting GI SETs with ESD and STER to explore the efficacy of this technique and the nature of GI SETs. Thirty-nine patients with GI SETs who underwent ESD and STER were analyzed retrospectively. Patients' clinical data, procedure parameters, pathologic diagnosis, and outcomes were collected and analyzed. Thirty-nine GI SETs were resected, 36 by ESD, and 3 by STER. Thirty-eight (97.4%) tumors were from the submucosal layer and one from the muscular layer. Fifteen, 13, and 11 tumors were located in the esophagus, stomach, and colon, respectively. The mean tumor size was 16.8 +/- 1.3 mm. In the esophagus, leiomyomas were the most common diagnosis, followed by the lymphoepithelial cyst, epithelial hyperplasia, focal lymphoid hyperplasia, and dilated submucosal gland. The esophageal tumor from the muscularis propria was GI stromal tumor (GIST). In the stomach, 53.8% of the submucosal tumors were ectopic pancreas, followed by lipoma, calcifying fibrous tumor, GIST, submucosal inflammation, and angiodysplasia with focal ulcers. The submucosal tumors in the colon were diagnosed as neuroendocrine tumors (NETs, n = 5), lipomas (n = 4), leiomyoma (n = 1), and foreign body-related granuloma (n = 1). Seven (17.9%) of all tumors were NETs and GISTs with malignant potential. All cases were resected completely. The overall procedural time was 37.9 +/- 4.6 minutes. Severe fibrosis was more likely encountered in the stomach with a rate of 46.1%, with the gastric ectopic pancreas having a 71.4% severe fibrosis rate. Only 13 patients completed follow-up endoscopic ultrasound or endoscopy within 1 year after ESD and STER, and no recurrence was noted. There were no major complications, and none of the patients required admission to the intensive care unit or surgery. Three perforations were encountered during STER, which were smoothly managed with hemoclips without surgery. ESD and STER can be an effective modality for the diagnosis and management of GI SETs in a selected group of patients. Most of the lesions are benign, whereas some have malignant potential. More studies on the nature of GI SETs are required to justify the indications of endoscopic resection.