Value of endoscopic submucosal dissection and endoscopic full-thickness resection in the treatment of upper gastrointestinal submucosal tumors:197 cases analysis

ObjectiveTo assess the efficacy and safety of endoscopic submucosal dissection(ESD) and endoscopic full-thickness resection(EFR) in the treatment of the upper gastrointestinal submucosal tumors(SMT).

MethodsThe clinical data of 197 patients with upper gastrointestinal SMT were retrospectively analyzed.All patients were treated with ESD or EFR.The tumor resection rate, operation time, intraoperative perforation rate, postoperative bleeding rate and histopathological results in the patients were evaluated.

ResultsAmong the 197 patients, 154 cases originated from submucosa, were treated with ESD, and the lesions were completely stripped.The average operative time(from lesion labeling to complete dissection) of ESD was (24.0±3.6)min, no postoperative bleeding occurred, the perforation occurred during the operation, and the wound was successfully closed by titanium clips.Forty-three cases originated from submucosa, the tumors tightly adhered to the serous membrane layer, and were treated with EFR.Complete dissections in 42 cases were successfully performed, and the wound was successfully closed by titanium clips and nylon pocketbook suture under gastroscope.One case was changed to surgical operation due to the large tumor body and difficulty in adhesion and dissection.The mean operation time of EFR was (52.0±9.7)min, no hemorrhage occurred after operation, and the aortic perforation in the patients were found during EFR.The results of pathological and immunohistostaining examination identified the leiomyoma in 75 cases, ectopic pancreas in 43 cases, stromal tumor in 39 cases, lipoma in 26 cases, cyst in 4 cases, neuroendocrine tumor in 3 cases, schwannoma in 3 cases, adenomyoma in 2 cases, hemangioma in 1 case and lymphangioma in 1 case.All patients were followed up for 3 to 18 months, the median follow-up time was 7 months, and there was no recurrence case.

ConclusionsESD and EFR technology can safely and completely remove the upper gastrointestinal SMT, and provide a complete and reliable pathological diagnosis.With the advantages of small trauma and quick recovery, it is worthy of further clinical promotion.