Hwang Jae Chul, Kim Jin Hong, Kim Jang Hee, Shin Sung Jae, Cheong Jae Youn, Lee Kee Myung, Yoo Byung Moo, Lee Kwang Jae, Cho Sung Won
Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1281-6.
BACKGROUND/AIMS: Endoscopic resection for pathologic diagnosis and complete eradication of subepithelial tumors (SETs) has offered less invasive alternatives to surgical resection. The aim of this study is to evaluate feasibility of endoscopic resection for the treatment of gastric SETs originated from the muscularis propria layer and to determine related factors in the success rate of endoscopic resection.
In 25 patients with a well marginated tumor which was 2 to 5cm and showed an endoluminal growth pattern according to endoscopic ultrasound (EUS) findings, endoscopic resection with incisional enucleation method was attempted in those who's SETs originated in the muscularis propria. The success rate, causes of failure, complications, EUS findings and histopathologic findings were analyzed in this retrospective single-center study.
Complete endoscopic resection of SETs was successful in 64% (16/25 tumors). Mean tumor size was 28.7mm (range 20-50mm). The histological diagnosis was leiomyoma for thirteen lesions and gastrointestinal stromal tumor for three lesions. The successful resection rate of tumors which had underlying muscle layer was 93.8% (15/16), but that of tumors which did not show any under EUS was 11.1% (1/9) (p < 0.001). All three perforations occurred in the cases of tumors which did not show underlying muscle layer under EUS during dissection of the tumor base from surrounding tissue (p = 0.037),
Endoscopic resection for the treatment of SETs arose from the muscularis propria seems to be feasible and effective only in the well marginated tumors which showed underlying muscle layer under EUS.
背景/目的：内镜下切除用于病理诊断及彻底根除上皮下肿瘤（SETs），为手术切除提供了侵入性较小的替代方法。本研究旨在评估内镜下切除治疗起源于固有肌层的胃SETs的可行性，并确定内镜下切除成功率的相关因素。
对25例肿瘤边界清晰、大小为2至5cm且根据内镜超声（EUS）检查结果呈腔内生长模式的患者进行研究，对SETs起源于固有肌层的患者尝试采用切开摘除法进行内镜下切除。在这项回顾性单中心研究中，分析了成功率、失败原因、并发症、EUS检查结果及组织病理学检查结果。
64%（16/25个肿瘤）的SETs实现了内镜下完全切除。肿瘤平均大小为28.7mm（范围20 - 50mm）。组织学诊断为平滑肌瘤13例，胃肠道间质瘤3例。有肌层的肿瘤成功切除率为93.8%（15/16），而EUS检查未显示肌层的肿瘤成功切除率为11.1%（1/9）（p < 0.001）。所有3例穿孔均发生在EUS检查未显示肌层的肿瘤在从周围组织分离肿瘤基底部的过程中（p = 0.037）。
内镜下切除治疗起源于固有肌层的SETs似乎仅在EUS检查显示有肌层的边界清晰的肿瘤中可行且有效。
