Lee Jung Min, Yoo In Kyung, Hong Sung Pyo, Cho Joo Young, Cho Young Kwan
Department of Gastroenterology, CHA Gangnam Medical Center, College of Medicine, Cha University, Seoul, South Korea.
Department of Gastroenterology, CHA Bundang Medical Center, College of Medicine, Cha University, Seongnam-si, South Korea.
J Gastroenterol Hepatol. 2021 Sep;36(9):2558-2561. doi: 10.1111/jgh.15505. Epub 2021 Mar 31.
The removal of subepithelial tumors (SETs) is challenging, particularly in tumors originating from the muscularis propria (MP) in the upper gastrointestinal (GI) tract, owing to the high risk of perforation. We developed mechanical spray lumpectomy (MSL), which is a novel method to safely and easily remove the tumor. This study aimed to evaluate the feasibility and safety of MSL as a novel endoscopic treatment for gastric subepithelial lesions.
We performed MSL in a total of 13 patients with upper GI SETs originating from the MP layer. First, mucosectomy was performed using a conventional snare. Repeated injections were performed towards the subserosal layer. After injection, the lesion was mechanically pushed to separate the MP layer using an endoscopic cap. Finally, the mucosa, submucosa, and MP layer with SETs were completely dissected using the spray coagulation mode, and the remaining defect was closed with clipping.
All tumors were completely resected. The mean procedure time was 84.38 ± 41.73 min. There were four leiomyomas, six GI stromal tumors, one mucosa-associated lymphoid tissue lymphoma, and two ectopic pancreases. Although small perforation occurred in only one case, the defect was successfully closed using hemostatic clipping. Moreover, no serious complications related to MSL were encountered during or after the procedure. No residual lesion or recurrence was observed during the follow-up period.
Mechanical spray lumpectomy can be a novel method that provides a safe and minimally invasive endoscopic treatment for upper GI SETs originating from the MP layer.
上皮下肿瘤（SETs）的切除具有挑战性，尤其是在上消化道（GI）中起源于固有肌层（MP）的肿瘤，因为穿孔风险高。我们开发了机械喷雾肿块切除术（MSL），这是一种安全、简便地切除肿瘤的新方法。本研究旨在评估MSL作为一种新型内镜治疗胃上皮下病变的可行性和安全性。
我们对13例起源于MP层的上消化道SETs患者进行了MSL。首先，使用传统圈套器进行黏膜切除术。向浆膜下层反复注射。注射后，使用内镜帽将病变机械性推离以分离MP层。最后，使用喷雾凝固模式将带有SETs的黏膜、黏膜下层和MP层完整切除，并使用夹子封闭剩余的缺损。
所有肿瘤均被完整切除。平均手术时间为84.38±41.73分钟。其中有4例平滑肌瘤、6例胃肠道间质瘤、1例黏膜相关淋巴组织淋巴瘤和2例异位胰腺。虽然仅1例发生小穿孔，但使用止血夹成功封闭了缺损。此外，术中及术后均未遇到与MSL相关的严重并发症。随访期间未观察到残留病变或复发。
机械喷雾肿块切除术可成为一种为起源于MP层的上消化道SETs提供安全、微创内镜治疗的新方法。
