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Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up: a prospective study of 224 cases in a single medical center.
Surg Endosc 2016; 30(10):4206-13SE

Abstract

BACKGROUND AND AIMS

Diagram, diagnosis, and treatment with endoscopic submucosal dissection (ESD) for upper gastrointestinal submucosal tumors (SMTs) remain controversial, although endoscopic ultrasonography (EUS) and ESD have been established in diagnosis and treatment of SMTs in decades, respectively. In this study, we have investigated prospectively the profile of upper gastrointestinal SMTs, assessed the effect and feasibility of ESD in upper gastrointestinal SMTs treatment, as well as value of EUS in pre-ESD diagnosis and post-ESD follow-up for gastrointestinal SMTs.

METHODS

The upper gastrointestinal SMTs patients detected with endoscopy were further checked by EUS, then received series ESD treatment, and fulfilled 3- and 12-month follow-up EUS detection between July 2011 and March 2015. The parameters of SMTs with EUS examination (size, original layer) and treatment with ESD (en bloc resection rate, procedure time, procedure-related complications) were investigated and analyzed.

RESULTS

A total number of 224 patients with upper gastrointestinal SMTs were enrolled, and 108 (48.2 %) were men. The mean age was 50.4 ± 12.0 years (range 19-77 years). In total, 92 (41.1 %), 14 (6.3 %), 61 (27.2 %), 22 (9.8 %), 25 (11.2 %), and 10 (4.5 %) SMTs were located in esophagus, cardiac, fundus, body and antrum of stomach, duodenum, respectively. Two hundred and eight (92.9 %) patients were successfully treated with an en bloc ESD, while other 16 patients (7.1 %) suffered ESD failure (5.3 %, 12 case) or severe complications (1.8 %, 4 cases). The mean procedure time of ESD was 47.4 ± 27.3 min (range 10-180 min). The mean size of the SMTs measured with ESD samples was 13.6 ± 9.5 mm (range 4-113 mm). In total, 87 (38.8 %), 23 (10.3 %), and 114 (50.9 %) tumors originated from muscularis mucosa, submucosa, and muscularis propria, respectively. The majority of SMTs were leiomyoma (109, 48.7 %) and gastrointestinal stromal tumors (GIST) (77, 34.4 %), while other SMTs were confirmed as ectopic pancreas (21, 9.4 %), adenoid tumor (8, 3.6 %), lipoma (5, 2.2 %), neuroendocrine tumor (3, 1.3 %), and granulosa cell tumor (1, 0.4 %). The accuracy rate of EUS in pathological diagnosis or original layer was 82.6 % (185/224) or 74.6 % (167/224). Residual tumors were detected with EUS in 3 patients (1.3 %) in 3-month follow-up and no recurrence during 12-month follow-up period.

CONCLUSIONS

The predominant SMTs in upper gastrointestinal tract were leiomyoma in esophageal tumors which originated from muscularis mucosae and GIST in stomach which originated from muscularis propria detected satisfactorily with EUS. This study showed that ESD was a safe and effective treatment for upper gastrointestinal SMTs.

Authors+Show Affiliations

Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China. minhuch@yeah.net.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26823060

Citation

He, Ganqing, et al. "Feasibility of Endoscopic Submucosal Dissection for Upper Gastrointestinal Submucosal Tumors Treatment and Value of Endoscopic Ultrasonography in Pre-operation Assess and Post-operation Follow-up: a Prospective Study of 224 Cases in a Single Medical Center." Surgical Endoscopy, vol. 30, no. 10, 2016, pp. 4206-13.
He G, Wang J, Chen B, et al. Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up: a prospective study of 224 cases in a single medical center. Surg Endosc. 2016;30(10):4206-13.
He, G., Wang, J., Chen, B., Xing, X., Wang, J., Chen, J., ... Chen, M. (2016). Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up: a prospective study of 224 cases in a single medical center. Surgical Endoscopy, 30(10), pp. 4206-13. doi:10.1007/s00464-015-4729-1.
He G, et al. Feasibility of Endoscopic Submucosal Dissection for Upper Gastrointestinal Submucosal Tumors Treatment and Value of Endoscopic Ultrasonography in Pre-operation Assess and Post-operation Follow-up: a Prospective Study of 224 Cases in a Single Medical Center. Surg Endosc. 2016;30(10):4206-13. PubMed PMID: 26823060.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up: a prospective study of 224 cases in a single medical center. AU - He,Ganqing, AU - Wang,Jinhui, AU - Chen,Baili, AU - Xing,Xiangbin, AU - Wang,Jinping, AU - Chen,Jie, AU - He,Yao, AU - Cui,Yi, AU - Chen,Minhu, Y1 - 2016/01/28/ PY - 2015/09/25/received PY - 2015/12/15/accepted PY - 2016/1/30/entrez PY - 2016/1/30/pubmed PY - 2017/7/21/medline KW - Efficacy KW - Endoscopic KW - Submucosal tumor KW - Ultrasonography SP - 4206 EP - 13 JF - Surgical endoscopy JO - Surg Endosc VL - 30 IS - 10 N2 - BACKGROUND AND AIMS: Diagram, diagnosis, and treatment with endoscopic submucosal dissection (ESD) for upper gastrointestinal submucosal tumors (SMTs) remain controversial, although endoscopic ultrasonography (EUS) and ESD have been established in diagnosis and treatment of SMTs in decades, respectively. In this study, we have investigated prospectively the profile of upper gastrointestinal SMTs, assessed the effect and feasibility of ESD in upper gastrointestinal SMTs treatment, as well as value of EUS in pre-ESD diagnosis and post-ESD follow-up for gastrointestinal SMTs. METHODS: The upper gastrointestinal SMTs patients detected with endoscopy were further checked by EUS, then received series ESD treatment, and fulfilled 3- and 12-month follow-up EUS detection between July 2011 and March 2015. The parameters of SMTs with EUS examination (size, original layer) and treatment with ESD (en bloc resection rate, procedure time, procedure-related complications) were investigated and analyzed. RESULTS: A total number of 224 patients with upper gastrointestinal SMTs were enrolled, and 108 (48.2 %) were men. The mean age was 50.4 ± 12.0 years (range 19-77 years). In total, 92 (41.1 %), 14 (6.3 %), 61 (27.2 %), 22 (9.8 %), 25 (11.2 %), and 10 (4.5 %) SMTs were located in esophagus, cardiac, fundus, body and antrum of stomach, duodenum, respectively. Two hundred and eight (92.9 %) patients were successfully treated with an en bloc ESD, while other 16 patients (7.1 %) suffered ESD failure (5.3 %, 12 case) or severe complications (1.8 %, 4 cases). The mean procedure time of ESD was 47.4 ± 27.3 min (range 10-180 min). The mean size of the SMTs measured with ESD samples was 13.6 ± 9.5 mm (range 4-113 mm). In total, 87 (38.8 %), 23 (10.3 %), and 114 (50.9 %) tumors originated from muscularis mucosa, submucosa, and muscularis propria, respectively. The majority of SMTs were leiomyoma (109, 48.7 %) and gastrointestinal stromal tumors (GIST) (77, 34.4 %), while other SMTs were confirmed as ectopic pancreas (21, 9.4 %), adenoid tumor (8, 3.6 %), lipoma (5, 2.2 %), neuroendocrine tumor (3, 1.3 %), and granulosa cell tumor (1, 0.4 %). The accuracy rate of EUS in pathological diagnosis or original layer was 82.6 % (185/224) or 74.6 % (167/224). Residual tumors were detected with EUS in 3 patients (1.3 %) in 3-month follow-up and no recurrence during 12-month follow-up period. CONCLUSIONS: The predominant SMTs in upper gastrointestinal tract were leiomyoma in esophageal tumors which originated from muscularis mucosae and GIST in stomach which originated from muscularis propria detected satisfactorily with EUS. This study showed that ESD was a safe and effective treatment for upper gastrointestinal SMTs. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/26823060/Feasibility_of_endoscopic_submucosal_dissection_for_upper_gastrointestinal_submucosal_tumors_treatment_and_value_of_endoscopic_ultrasonography_in_pre_operation_assess_and_post_operation_follow_up:_a_prospective_study_of_224_cases_in_a_single_medical_center_ L2 - https://dx.doi.org/10.1007/s00464-015-4729-1 DB - PRIME DP - Unbound Medicine ER -