Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, North of Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China.
Surg Endosc. 2018 Jan;32(1):536-543. doi: 10.1007/s00464-017-5704-9. Epub 2017 Jun 29.
Endoscopic mucosa-sparing lateral dissection (EMSLD) was developed by our group, and is used to remove gastric submucosal tumor (SMT). This study aims to evaluate the feasibility and safety of this method.
This retrospective study included 25 patients who underwent EMSLDs at an endoscopy center as a national key unit in china from October 2015 to July 2016. The main data collected were the size of the gastric SMT, its location and origin, en bloc resection rate, operating time, intraoperative and postoperative complications, hospitalization expense, hospital days, and follow-up after hospital discharge.
The mean (SD) size of the gastric SMTs was 18.3 (5.9) mm; 96% (24/25) of the tumors originated in the muscularis propria; and 64% (16/25) and 28% (7/25) were located in the gastric fundus and gastric body, respectively. The rate of en bloc resection was 96% (24/25), and the rate of intraoperative perforations due to endoscopic full-thickness resection was 48% (12/25). All wounds and perforations were effectively closed using endoscopic clips combined with the retained mucosa. The mean operative time was 74.2 (38.0) min. Delayed bleeding and perforation were not observed.
Endoscopic mucosa-sparing lateral dissection is safe and feasible for the removal of gastric SMTs. The wound can be effectively closed using the retained mucosa and endoscopic clips, even if perforation has occurred. EMSLD provides an alternative to the resection of gastric SMTs, especially for tumors with a risk of intraoperative perforation.
内镜黏膜下剥离术（endoscopic mucosa-sparing lateral dissection，EMSLD）由我们团队开发，用于切除胃黏膜下肿瘤（submucosal tumor，SMT）。本研究旨在评估该方法的可行性和安全性。
这是一项回顾性研究，纳入了 2015 年 10 月至 2016 年 7 月在中国一个国家级内镜中心接受 EMSLD 的 25 例患者。主要收集的数据包括胃 SMT 的大小、位置和起源、整块切除率、手术时间、术中及术后并发症、住院费用、住院天数以及出院后的随访情况。
胃 SMT 的平均（SD）大小为 18.3（5.9）mm；96%（24/25）的肿瘤起源于固有肌层；64%（16/25）和 28%（7/25）的肿瘤分别位于胃底和胃体。整块切除率为 96%（24/25），因内镜全层切除导致的术中穿孔率为 48%（12/25）。所有伤口和穿孔均采用内镜夹联合保留黏膜有效闭合。平均手术时间为 74.2（38.0）min。未观察到迟发性出血和穿孔。
内镜黏膜下剥离术切除胃 SMT 是安全可行的。即使发生穿孔，也可以采用保留黏膜和内镜夹有效闭合创面。EMSLD 为胃 SMT 的切除提供了一种替代方法，特别是对于术中穿孔风险较高的肿瘤。
