Lin Kuang-Fang, Chen Chien-Chuan, Chen Chieh-Chang, Han Ming-Lun, Wang Hsiu-Po, Wu Ming-Shiang, Tseng Ping-Huei
Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan.
Endoscopic Division, Department of Integrated Diagnostic & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Surg Endosc. 2025 Mar;39(3):1961-1971. doi: 10.1007/s00464-025-11562-2. Epub 2025 Jan 27.
This study aimed to investigate the clinical characteristics and esophageal motility of patients with gastric cardia submucosal tumors (SMTs) and the associated changes after endoscopic resection based on high-resolution impedance manometry (HRIM).
From our electronic database, we identified patients who underwent pre-operative evaluation of gastric cardia SMTs between 2015 and 2023. All patients completed standardized symptom questionnaires and underwent endoscopic ultrasonography and HRIM. Endoscopic resection via submucosal dissection or submucosal tunnel endoscopic resection was performed, followed by esophagogastroduodenoscopy and HRIM three months later. Esophageal motility on HRIM was compared based on the updated Chicago Classification v4.0.
Thirty patients (mean age, 47.4 ± 12.8 years; male, 50%) were analyzed. Most patients were asymptomatic (43.3%), while others presented with epigastralgia, regurgitation, chest pain, or dysphagia. On endoscopic ultrasonography, the average tumor size was 16.7 ± 4.5 mm (range, 10.0-30.0 mm), and most tumors originated from the fourth layer (80%). On HRIM, eight patients (26.7%) had abnormal esophageal motility, including five with ineffective esophageal motility (IEM) and three with esophagogastric junction outflow obstruction. Complete resection was achieved in 25 of the 27 patients (92.6%) who underwent endoscopic treatment. Pathology revealed leiomyomas (96%) and gastrointestinal stromal tumors (4%). No significant differences in symptom profiles or HRIM parameters were observed after tumor resection. Three patients with pre-operative IEM exhibited normal motility at the follow-up HRIM.
Up to 26.7% of patients with gastric cardia SMTs had abnormal esophageal motility on HRIM. Endoscopic resection of these SMTs was effective and safe and appeared to improve esophageal motility in patients with IEM.
本研究旨在基于高分辨率阻抗测压法（HRIM）调查胃贲门黏膜下肿瘤（SMTs）患者的临床特征和食管动力，以及内镜切除术后的相关变化。
从我们的电子数据库中，我们识别出2015年至2023年间接受胃贲门SMTs术前评估的患者。所有患者均完成标准化症状问卷，并接受内镜超声检查和HRIM。通过黏膜下剥离或黏膜下隧道内镜切除术进行内镜切除，三个月后进行食管胃十二指肠镜检查和HRIM。根据更新的芝加哥分类v4.0比较HRIM上的食管动力。
分析了30例患者（平均年龄47.4±12.8岁；男性占50%）。大多数患者无症状（43.3%），其他患者表现为上腹痛、反流、胸痛或吞咽困难。在内镜超声检查中，肿瘤平均大小为16.7±4.5毫米（范围为10.0 - 30.0毫米），大多数肿瘤起源于第四层（80%）。在HRIM上，8例患者（26.7%）食管动力异常，包括5例食管动力无效（IEM）和3例食管胃交界流出道梗阻。27例接受内镜治疗的患者中有25例（92.6%）实现了完全切除。病理显示平滑肌瘤（96%）和胃肠道间质瘤（4%）。肿瘤切除后症状特征或HRIM参数未观察到显著差异。3例术前IEM患者在随访HRIM时表现出正常动力。
高达26.7%的胃贲门SMTs患者在HRIM上存在食管动力异常。这些SMTs的内镜切除有效且安全，似乎改善了IEM患者的食管动力。
