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Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer.
Gastrointest Endosc 2011; 74(6):1194-200GE

Abstract

BACKGROUND

The technique of endoscopic submucosal dissection (ESD), which was developed for en bloc resection of large lesions in the stomach, has been widely accepted for the treatment of early gastric cancer. It is being used for muscularis propria tumors of the digestive tract and has produced positive therapeutic effects.

OBJECTIVE

To study the feasibility of ESD for the removal of esophageal muscularis propria tumors and to evaluate the efficacy and safety of ESD for this treatment.

DESIGN

Single-center, retrospective study.

SETTING

University hospital.

PATIENTS

Thirty esophageal muscularis propria tumors from 28 patients were treated with ESD between December 2008 and December 2010. We defined esophageal muscularis propria tumors as esophageal submucosal tumors originating from the muscularis propria layer.

INTERVENTION

ESD.

MAIN OUTCOME MEASUREMENTS

Tumor characteristics, complications, en bloc resection rate, and local recurrence rate were evaluated.

RESULTS

Among the 28 patients, 11 were women (39.3%). The median age was 49.32 years (range 22-62 years). Mean (± SD) tumor size was 1.25 ± 0.70 cm (range 0.5-3.0 cm). Except for 2 failed cases (one changed to surgery and the other changed to nylon ligation), 26 cases with 28 tumors (2 cases had 2 tumors) originating from the muscularis propria of the esophagus were successfully resected by ESD. The en bloc resection rate was 93.3% (28/30). The median ESD procedure time was 73.5 minutes (range 30-120 minutes). Perforation occurred in 2 cases during dissection of the lesion, which was closed with metal endoclips. Pneumothorax occurred after the treatment in both cases. Closed thoracic drainages were initiated, and the patients recovered quickly without surgery. Pathological examination confirmed 27 leiomyomas and 1 GI stromal tumor. The curative resection rate was 100% (28/28). There was no recurrence during a 3 to 27-month follow-up period.

LIMITATIONS

The limitation of the study was its retrospective design.

CONCLUSION

ESD offers the promise of localized treatment of esophageal muscularis propria tumors with relatively few complications and low mortality. It makes the resection of whole lesions possible and provides precise histologic information.

Authors+Show Affiliations

Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21963065

Citation

Shi, Qiang, et al. "Endoscopic Submucosal Dissection for Treatment of Esophageal Submucosal Tumors Originating From the Muscularis Propria Layer." Gastrointestinal Endoscopy, vol. 74, no. 6, 2011, pp. 1194-200.
Shi Q, Zhong YS, Yao LQ, et al. Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc. 2011;74(6):1194-200.
Shi, Q., Zhong, Y. S., Yao, L. Q., Zhou, P. H., Xu, M. D., & Wang, P. (2011). Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointestinal Endoscopy, 74(6), pp. 1194-200. doi:10.1016/j.gie.2011.07.039.
Shi Q, et al. Endoscopic Submucosal Dissection for Treatment of Esophageal Submucosal Tumors Originating From the Muscularis Propria Layer. Gastrointest Endosc. 2011;74(6):1194-200. PubMed PMID: 21963065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. AU - Shi,Qiang, AU - Zhong,Yun-Shi, AU - Yao,Li-qing, AU - Zhou,Ping-hong, AU - Xu,Mei-dong, AU - Wang,Ping, Y1 - 2011/10/01/ PY - 2011/04/04/received PY - 2011/07/20/accepted PY - 2011/10/4/entrez PY - 2011/10/4/pubmed PY - 2012/4/27/medline SP - 1194 EP - 200 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 74 IS - 6 N2 - BACKGROUND: The technique of endoscopic submucosal dissection (ESD), which was developed for en bloc resection of large lesions in the stomach, has been widely accepted for the treatment of early gastric cancer. It is being used for muscularis propria tumors of the digestive tract and has produced positive therapeutic effects. OBJECTIVE: To study the feasibility of ESD for the removal of esophageal muscularis propria tumors and to evaluate the efficacy and safety of ESD for this treatment. DESIGN: Single-center, retrospective study. SETTING: University hospital. PATIENTS: Thirty esophageal muscularis propria tumors from 28 patients were treated with ESD between December 2008 and December 2010. We defined esophageal muscularis propria tumors as esophageal submucosal tumors originating from the muscularis propria layer. INTERVENTION: ESD. MAIN OUTCOME MEASUREMENTS: Tumor characteristics, complications, en bloc resection rate, and local recurrence rate were evaluated. RESULTS: Among the 28 patients, 11 were women (39.3%). The median age was 49.32 years (range 22-62 years). Mean (± SD) tumor size was 1.25 ± 0.70 cm (range 0.5-3.0 cm). Except for 2 failed cases (one changed to surgery and the other changed to nylon ligation), 26 cases with 28 tumors (2 cases had 2 tumors) originating from the muscularis propria of the esophagus were successfully resected by ESD. The en bloc resection rate was 93.3% (28/30). The median ESD procedure time was 73.5 minutes (range 30-120 minutes). Perforation occurred in 2 cases during dissection of the lesion, which was closed with metal endoclips. Pneumothorax occurred after the treatment in both cases. Closed thoracic drainages were initiated, and the patients recovered quickly without surgery. Pathological examination confirmed 27 leiomyomas and 1 GI stromal tumor. The curative resection rate was 100% (28/28). There was no recurrence during a 3 to 27-month follow-up period. LIMITATIONS: The limitation of the study was its retrospective design. CONCLUSION: ESD offers the promise of localized treatment of esophageal muscularis propria tumors with relatively few complications and low mortality. It makes the resection of whole lesions possible and provides precise histologic information. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/21963065/Endoscopic_submucosal_dissection_for_treatment_of_esophageal_submucosal_tumors_originating_from_the_muscularis_propria_layer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(11)01979-1 DB - PRIME DP - Unbound Medicine ER -