Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, 210008, China.
Department of Geriatrics, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China.
Surg Endosc. 2018 May;32(5):2575-2582. doi: 10.1007/s00464-017-5985-z. Epub 2017 Dec 20.
We developed a novel method of endoscopic subserosal dissection (ESSD) for removal of subepithelial tumors (SETs) originating from the muscularis propria (MP) layer in the upper gastrointestinal (GI) tract. The aim of this study was to evaluate the efficacy, safety, and clinical outcome of this method.
Eleven patients with upper GI SETs originating from the MP layer were treated by ESSD between October 2016 and March 2017. ESSD technique consists of six major procedures: (1) incising the mucosal and submucosal layer around the lesion and exposing MP layer; (2) continuous injection was performed while the injection needle slowly moved from the MP layer toward the subserosal layer; (3) incising MP layer; (4) subserosal injection was performed to further separate the serosa from the MP layer; (5) the mucosa, submucosa, and MP layer including SET were carefully dissected en bloc; and (6) closure of the gastric-wall defect with endoscopic techniques. Primary outcome including clinical procedural success and procedure-related adverse events were documented.
ESSD was successfully performed in 11 patients. The complete resection rate was 100%, and the mean operation time was 51 (range 22-76) min. The mean resected lesion size was 27 (range 15-40) mm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (8/11), heterotopic pancreas (1/11), hamartoma (1/11), and leiomyoma (1/11). The small perforations occurred in two patients (4 × 4 and 5 × 5 mm, respectively) during the operation. All perforations and defects were closed successfully by endoscopic techniques. No GI bleeding, peritonitis, abdominal abscess, and other adverse events were observed. No lesion residual or recurrence was found during the follow-up period (mean 18 weeks; range 10-29 weeks).
ESSD seems to be an efficacious, safe, and minimally invasive treatment for patients with upper GI SETs originating from the MP layer, making it possible to resect deep lesions, provide precise pathological diagnosis, and maintain the integrity of serosa.
我们开发了一种新的内镜黏膜下剥离术（ESSD）方法，用于切除起源于上消化道（GI）黏膜固有肌层（MP）层的黏膜下肿瘤（SET）。本研究旨在评估该方法的疗效、安全性和临床结果。
2016 年 10 月至 2017 年 3 月，我们对 11 例起源于 MP 层的上 GI SET 患者行 ESSD 治疗。ESSD 技术包括以下 6 个主要步骤：（1）围绕病变切开黏膜和黏膜下层，暴露 MP 层；（2）在注射针缓慢从 MP 层向黏膜下层移动的同时进行连续注射；（3）切开 MP 层；（4）进行黏膜下注射，进一步将浆膜与 MP 层分离；（5）仔细整块剥离黏膜、黏膜下层和包括 SET 的 MP 层；（6）使用内镜技术闭合胃壁缺损。记录主要结果，包括临床操作成功率和与操作相关的不良事件。
11 例患者均成功完成 ESSD。完全切除率为 100%，平均手术时间为 51（22-76）min。平均切除病变大小为 27（15-40）mm。这些病变的病理诊断包括胃肠道间质瘤（8/11）、异位胰腺（1/11）、错构瘤（1/11）和平滑肌瘤（1/11）。术中 2 例患者（分别为 4×4 和 5×5mm）发生小穿孔。所有穿孔和缺损均成功通过内镜技术闭合。未观察到 GI 出血、腹膜炎、腹腔脓肿和其他不良事件。随访期间（平均 18 周；范围 10-29 周）未发现病变残留或复发。
ESSD 似乎是一种有效、安全且微创的治疗方法，适用于起源于 MP 层的上 GI SET 患者，可切除深部病变，提供精确的病理诊断，并保持浆膜的完整性。
