Department of Gastroenterology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China.
Can J Gastroenterol Hepatol. 2021 Jun 30;2021:9916927. doi: 10.1155/2021/9916927. eCollection 2021.
Submucosal tunneling endoscopic resection (STER) has effectively removed esophageal submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. However, clinical failure and adverse events of STER remain concerned. In this study, we described a mark-guided STER (markings before creating entry point) and evaluated its feasibility and safety for esophageal SMTs originating from MP.
Patients receiving the mark-guided STER from October 2017 to July 2020 were included and followed up (ranged from 3 to 30 months). The primary outcomes included complete resection, en bloc resection, and R0 resection rates. The secondary outcomes included procedure duration, main complication, and residual lesions.
A total of 242 patients with 242 SMTs (median diameter of 22 mm, ranging from 7 mm to 40 mm) received the mark-guided STER. The median procedure duration was 55 min (ranging from 35 min to 115 min). The complete resection, en bloc resection, and R0 resection rates were 100%, 98.3%, and 97.5%, respectively. The adverse event rate was 4.5%. However, there was no severe complication. No residual SMTs were detected during the follow-up period. Logistic regression demonstrated that the SMT size and procedure duration were independent factors associated with en bloc resection (=0.02 and =0.04, respectively). Moreover, logistic regression demonstrated that the SMT size was an independent risk factor for main complications (=0.02).
Mark-guided STER was feasible and safe to remove esophageal SMTs ≦40 mm. However, it is necessary to further verify the feasibility and safety for the esophageal SMTs >40 mm.
黏膜下隧道内镜切除术（STER）已有效地切除起源于固有肌层（MP）的食管黏膜下肿瘤（SMT）。然而，STER 的临床失败和不良事件仍令人担忧。在本研究中，我们描述了一种标记引导的STER（在创建入口点之前进行标记），并评估了其对起源于 MP 的食管 SMT 的可行性和安全性。
纳入 2017 年 10 月至 2020 年 7 月接受标记引导STER 的患者，并进行随访（3-30 个月）。主要结局包括完全切除率、整块切除率和 R0 切除率。次要结局包括手术时间、主要并发症和残留病变。
共 242 例 242 个 SMT（中位直径 22mm，7-40mm）患者接受标记引导STER。中位手术时间为 55min（35-115min）。完全切除率、整块切除率和 R0 切除率分别为 100%、98.3%和 97.5%。不良事件发生率为 4.5%。但无严重并发症。随访期间未发现残留 SMT。Logistic 回归分析表明，SMT 大小和手术时间是整块切除的独立相关因素（=0.02 和=0.04）。此外，Logistic 回归分析表明，SMT 大小是主要并发症的独立危险因素（=0.02）。
标记引导STER 是一种安全可行的方法，可用于切除直径≦40mm 的食管 SMT。然而，对于直径>40mm 的食管 SMT，还需要进一步验证其可行性和安全性。
