Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Gastroenterology, Royal Adelaide Hospital, South Adelaide, Australia.
Gastrointest Endosc. 2018 Jul;88(1):160-167. doi: 10.1016/j.gie.2018.02.032. Epub 2018 Feb 27.
The management of subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors can be challenging and traditionally requires a surgical resection that is not only invasive but may carry a significant risk of morbidity and mortality. We aimed to assess the feasibility, safety, and efficacy of a novel endoscopic technique termed submucosal tunnel endoscopic resection for extraluminal tumors (STER-ET).
We prospectively enrolled patients who underwent STER-ET for GI subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors located at the level of cardia or the proximal part of the lesser curvature of the stomach seen on cross-sectional imaging between January 2016 and March 2017.
Eight patients underwent STER-ET. The mean (± standard deviation) tumor size was 2.8 ± 0.6 cm and 2.3 ± 0.8 cm in longest and shortest dimension, respectively. The average procedure time was 67 ± 4.4 minutes. The rates of curative en bloc resection and en bloc retrieval was 100% and 87.5%, respectively. On final histology, 6 tumors were GI stromal tumors, 1 was a schwannoma, and 1 was a foregut cyst. Five patients had capnoperitoneum during the procedure and required abdominal decompression. One patient had a small mucosotomy successfully treated with a hemostatic clip. There were no major adverse events or deaths. The median length of hospital stay was 3 days. There was no residual tumor on surveillance imaging after a mean follow-up period of 10.0 ± 2.1 months.
STER-ET is a novel technique that appears to be safe and effective in achieving a curative resection for GI subepithelial tumors with a predominantly extraluminal growth pattern or extraluminal tumors in a selected group of patients. However, larger studies are required to validate our finding.
具有明显腔外生长模式或腔外肿瘤的黏膜下肿瘤的处理具有挑战性，传统上需要进行外科切除，不仅具有侵袭性，而且可能带来显著的发病率和死亡率。我们旨在评估一种新的内镜技术（称为黏膜下隧道内镜切除术治疗腔外肿瘤（STER-ET））的可行性、安全性和疗效。
我们前瞻性地招募了 2016 年 1 月至 2017 年 3 月间在横断面影像学上发现的具有明显腔外生长模式或位于贲门或胃小弯近端的 GI 黏膜下肿瘤或腔外肿瘤的患者，这些患者接受了 STER-ET 治疗。
8 名患者接受了 STER-ET。肿瘤的平均（±标准差）大小分别为 2.8 ± 0.6cm 和 2.3 ± 0.8cm，最长和最短径。平均手术时间为 67 ± 4.4 分钟。整块切除率和整块切除回收率分别为 100%和 87.5%。最终组织学上，6 个肿瘤为 GI 间质瘤，1 个为神经鞘瘤，1 个为前肠囊肿。5 名患者在手术过程中有气腹，需要腹部减压。1 例患者发生小的黏膜切开，成功用止血夹治疗。无重大不良事件或死亡。中位住院时间为 3 天。在平均 10.0 ± 2.1 个月的随访后，监测影像上无残留肿瘤。
STER-ET 是一种新的技术，似乎是安全有效的，可用于治疗具有明显腔外生长模式或腔外肿瘤的 GI 黏膜下肿瘤，适用于一组选定的患者。然而，需要更大的研究来验证我们的发现。
