Park Young Soo, Park Seung Woo, Kim Tae Il, Song Si Young, Choi Eric Hoon, Chung Jae Bock, Kang Jin Kyung
Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Gastrointest Endosc. 2004 Mar;59(3):409-15. doi: 10.1016/s0016-5107(03)02717-2.
Submucosal tumors often are found incidentally at upper endoscopy. Although the majority of the ones less than 5 cm in size are benign, periodic monitoring for incremental changes in size, which can be stressful and bothersome to patients, is essential. If relatively easy and safe, an endoscopic method of removal would be optimal treatment. Conventional endoscopic enucleation technically is difficult and often leads to serious complications, such as bleeding and perforation. A novel method for endoscopic enucleation of submucosal tumors with an insulated-tip electrosurgical knife is reported.
En bloc enucleation was attempted by using an insulated-tip electrosurgical knife in 15 patients (10 men, 5 women; median age 48 years) with submucosal tumors of the esophagus (5) or stomach (5 cardia/fundus, 4 body, one antrum). EUS was performed to determine the layer of origin and the exact size of the submucosal tumor.
Tumors arose in the muscularis propria in 11 cases, submucosa in two, and muscularis mucosa in one. Enucleation was relatively easy and successful in 14 cases. In one case, however, piecemeal resection was unavoidable because of fibrotic adhesions with the surrounding tissue; this tumor later was confirmed to be a glomus tumor. Median procedure time was 35 minutes (8-180 minutes) and median size of the submucosal tumors was 2x1.7 cm. The largest lesion, located in the esophagus, measured 6x3 cm. Histopathologic diagnoses included leiomyoma (9), GI stromal tumor (4), stromal tumor of unknown malignant potential (1), and glomus tumor (1). A small perforation occurred in one patient with a 2.5-cm tumor in the anterior wall of proximal gastric body but was managed successfully by endoscopic clip application. Follow-up endoscopy at 2 months in this patient revealed no tumor recurrence and complete healing of the treatment-related ulcer.
En bloc endoscopic enucleation of submucosal tumors by using an insulated-tip electrosurgical knife appears to be safer, easier, and less time consuming compared with previously described methods. However, further investigation and comparative studies are required to confirm the safety and efficacy of this method.
黏膜下肿瘤常在进行上消化道内镜检查时偶然发现。尽管大多数直径小于5厘米的此类肿瘤为良性，但对其大小的递增变化进行定期监测至关重要，而这可能给患者带来压力和困扰。如果相对简便且安全，内镜下切除方法将是最佳治疗方式。传统的内镜下摘除术在技术上难度较大，且常导致严重并发症，如出血和穿孔。本文报道了一种使用绝缘头电刀进行内镜下摘除黏膜下肿瘤的新方法。
对15例黏膜下肿瘤患者（10例男性，5例女性；中位年龄48岁）尝试使用绝缘头电刀进行整块摘除，这些患者的肿瘤位于食管（5例）或胃（贲门/胃底5例、胃体4例、胃窦1例）。进行超声内镜检查以确定黏膜下肿瘤的起源层次和确切大小。
11例肿瘤起源于固有肌层，2例起源于黏膜下层，1例起源于黏膜肌层。14例患者的摘除相对容易且成功。然而，有1例患者因与周围组织存在纤维化粘连而不得不进行分块切除；该肿瘤后来被证实为血管球瘤。中位手术时间为35分钟（8 - 180分钟），黏膜下肿瘤的中位大小为2×1.7厘米。最大的病变位于食管，大小为6×3厘米。组织病理学诊断包括平滑肌瘤（9例）、胃肠道间质瘤（4例）、恶性潜能不明的间质瘤（1例）和血管球瘤（1例）。1例胃体近端前壁有2.5厘米肿瘤的患者发生了小穿孔，但通过内镜夹闭成功处理。该患者在2个月时的随访内镜检查显示无肿瘤复发，且治疗相关溃疡完全愈合。
与先前描述的方法相比，使用绝缘头电刀进行内镜下整块摘除黏膜下肿瘤似乎更安全、更简便且耗时更少。然而，需要进一步的研究和对比研究来证实该方法的安全性和有效性。
