Digestive Endoscopy Department, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
Surg Endosc. 2020 Jan;34(1):417-428. doi: 10.1007/s00464-019-06785-z. Epub 2019 Apr 10.
Submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) were recently introduced to cure submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. This study aimed to compare clinical performance and safety of STER and ESE in treating esophageal SMTs originating from the MP layer.
From January 2011 to December 2017, retrospective data collection and follow-up were applied for all STER or ESE cases with esophageal SMTs originating from the MP layer in our endoscopy center, including clinical characteristics, procedure success, efficacy, and adverse events. Subgroup analysis was further done based on tumor size and origin.
90 STER and 77 ESE were enrolled in this study. There were no significant difference for patient characteristics, procedure performance, and complications for ESE and STER intervention (P > 0.05). STER was faster than ESE (3.90 mm/min vs 2.82 mm/min, P < 0.05). For large tumors (≥ 20 mm), both techniques had the similar performance (P > 0.05), while STER led to the shorter hospitalization (4.0d vs 7.0d, P < 0.05) and lower postoperative complication (16.3% vs 45.5%, P < 0.05). For small tumors (< 20 mm), STER achieved faster operation (STER vs ESE, 2.57 mm/min vs 1.83 mm/min, P < 0.05). Regardless of tumor origin, there were no significant difference for both techniques, but STER resulted in short hospitalization for SMTs from the deep MP layer (STER vs ESE, 5.0d vs 7.0d, P < 0.05). During the follow-up, 2 residual and 4 recurrence occurred in the STER group, as well as 1 residual and 2 recurrence in the ESE group.
Both STER and ESE were effective for treating esophageal SMTs originating from the MP layer. STER might be better due to its faster operation, less complications, and shorter hospitalization.
黏膜下隧道内镜切除术（STER）和内镜黏膜下挖除术（ESE）最近被引入以治疗起源于固有肌层（MP）层的黏膜下肿瘤（SMT）。本研究旨在比较STER 和 ESE 治疗起源于 MP 层的食管 SMT 的临床效果和安全性。
回顾性收集 2011 年 1 月至 2017 年 12 月期间，在我们的内镜中心行 ESE 或 STER 治疗起源于 MP 层的食管 SMT 的所有患者的数据，包括临床特征、手术成功率、疗效和不良事件。根据肿瘤大小和起源进一步进行亚组分析。
本研究共纳入 90 例行 STER 和 77 例行 ESE 的患者。ESE 和 STER 干预的患者特征、手术效果和并发症无显著差异（P>0.05）。STER 比 ESE 更快（3.90mm/min 比 2.82mm/min，P<0.05）。对于大肿瘤（≥20mm），两种技术的效果相似（P>0.05），但 STER 导致住院时间更短（4.0d 比 7.0d，P<0.05）和术后并发症更低（16.3%比 45.5%，P<0.05）。对于小肿瘤（<20mm），STER 操作更快（STER 比 ESE，2.57mm/min 比 1.83mm/min，P<0.05）。无论肿瘤起源如何，两种技术之间均无显著差异，但 STER 可缩短来自深层 MP 层的 SMT 的住院时间（STER 比 ESE，5.0d 比 7.0d，P<0.05）。在随访期间，STER 组有 2 例残留和 4 例复发，ESE 组有 1 例残留和 2 例复发。
STER 和 ESE 均能有效治疗起源于 MP 层的食管 SMT。由于操作更快、并发症更少和住院时间更短，STER 可能更好。
