Donatelli Gianfranco, Cereatti Fabrizio, Dumont Jean-Loup, Trelles Nelson, Lainas Panagiotis, Dammaro Carmelisa, Tranchart Hadrian, Pacini Filippo, Arienzo Roberto, Chevalier Jean-Marc, Danan David, Catheline Jean-Marc, Dagher Ibrahim
Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé 8 Place de l'Abbé G. Hénocque, 75013, Paris, France.
Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy.
Obes Surg. 2020 Nov;30(11):4636-4642. doi: 10.1007/s11695-020-04928-z. Epub 2020 Aug 17.
Submucosal tumors (SMTs) of the gastrointestinal tract are a rare pathological entity comprising a wide variety of neoplastic and non-neoplastic lesions. Even if most SMTs are benign tumors (e.g., leiomyomas), a smaller portion may have a malignant potential (e.g., gastrointestinal stromal tumor (GIST)). Preoperative diagnosis of SMT in bariatric patients may arise challenging clinical dilemmas. Long-term surveillance may be difficult after bariatric surgery. Moreover, according to SMT location, its presence may interfere with planned surgery. Submucosal tunneling endoscopic resection (STER) has emerged as an effective approach for minimally invasive en bloc excision of SMTs. This is the first case series of STER for SMTs before bariatric surgery.
Seven female patients underwent STER for removal of SMTs before bariatric surgery. All lesions were incidentally diagnosed at preoperative endoscopy. STER procedural steps comprised mucosal incision, submucosal tunneling, lesion enucleation, and closure of mucosal defect.
En bloc removal of SMT was achieved in all cases. Mean procedural time was of 45 min (SD 18.6). No adverse event occurred. Mean size of the lesions was 20.6 mm (SD 5.8). Histological diagnoses were 5 leyomiomas, 1 lipoma, and 1 low grade GIST. Bariatric procedure was performed after a mean period of 4.1 months (SD 1.6) from endoscopic resection.
STER is a safe and effective treatment for the management of SMT even in bariatric patients awaiting surgery. Preoperative endoscopic resection of SMTs has the advantages of reducing the need for surveillance and removing lesions that could interfere with planned surgery. STER did not altered accomplishment of bariatric procedures.
胃肠道黏膜下肿瘤（SMTs）是一种罕见的病理实体，包含多种肿瘤性和非肿瘤性病变。即使大多数SMTs是良性肿瘤（如平滑肌瘤），一小部分也可能具有恶性潜能（如胃肠道间质瘤（GIST））。肥胖症患者SMT的术前诊断可能会引发具有挑战性的临床困境。减肥手术后长期监测可能会很困难。此外，根据SMT的位置，其存在可能会干扰计划中的手术。黏膜下隧道内镜切除术（STER）已成为一种有效的微创整块切除SMTs的方法。这是减肥手术前进行STER治疗SMTs的首个病例系列。
7名女性患者在减肥手术前接受STER切除SMTs。所有病变均在术前内镜检查时偶然发现。STER手术步骤包括黏膜切开、黏膜下隧道、病变摘除和黏膜缺损闭合。
所有病例均实现了SMT的整块切除。平均手术时间为45分钟（标准差18.6）。未发生不良事件。病变的平均大小为20.6毫米（标准差5.8）。组织学诊断为5例平滑肌瘤、1例脂肪瘤和1例低级别GIST。在内镜切除术后平均4.1个月（标准差1.6）进行了减肥手术。
即使对于等待手术的肥胖症患者，STER也是治疗SMTs的一种安全有效的方法。术前内镜切除SMTs具有减少监测需求和切除可能干扰计划手术的病变的优点。STER并未改变减肥手术的完成情况。
