Lee Ah Young, Lim Sun Gyo, Cho Joo Young, Kim Seokhwi, Lee Kee Myung, Shin Sung Jae, Noh Choong-Kyun, Lee Gil Ho, Hur Hoon, Han Sang-Uk, Son Sang-Yong, Song Jeong Ho
Department of Gastroenterology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul 06135, South Korea.
Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, South Korea.
World J Gastroenterol. 2025 Jun 21;31(23):106261. doi: 10.3748/wjg.v31.i23.106261.
The spectrum of gastric submucosal tumors (SMTs) in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions, with gastrointestinal stromal tumors exhibiting inherent malignant potential. However, the diagnosis of SMTs remains challenging, and treatment methods, especially for tumors located at the cardia or esophagogastric junction (EGJ), are not well established. Minimally invasive techniques - such as endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER), and laparoscopic wedge resection (LWR) - have been developed for these lesions. However, comparative data on their feasibility, safety, and clinical outcomes in these locations remain limited.
To compare ESD, STER, and LWR for SMTs at the EGJ or cardia, focusing on procedural feasibility.
This single-center retrospective study included patients with SMTs less than 45 mm from the muscularis propria, growing intraluminally at the EGJ or cardia, and treated with ESD, STER, or LWR between July 2014 and September 2022. The primary outcome was relapse-free survival during follow-up.
The median age (interquartile range) was 53.0 (40.0-57.5), 43.0 (39.0-57.0), and 56.0 (43.0-64.0) years for ESD, STER, and LWR, respectively. The median follow-up time (interquartile range) was 60.0 (26.5-66.5), 24.0 (13.0-38.0), and 35.0 (21.0-60.0) months. LWR had the largest tumors (30.0 mm) and the highest rate of high-risk gastrointestinal stromal tumors (68.0%, < 0.001). Tumor recurrence occurred in one LWR patient (4.0%, = 0.600). and macroscopic resection rates were 100% ( = 1.000), but microscopic resection rates differed ( = 0.021). Significant minor complications occurred in 5 patients (10.0%), all grade IIIa. Tumor location (cardia/fundus, = 0.006) and prolonged procedure time ( < 0.001) were significantly associated with complications.
ESD, STER, and LWR are effective for SMTs at the EGJ and cardia, with minor complications associated with tumor location and procedure time, and comparable recurrence rates.
上消化道系统胃黏膜下肿瘤（SMTs）的范围从非肿瘤性病变到恶性病变，其中胃肠道间质瘤具有内在的恶性潜能。然而，SMTs的诊断仍然具有挑战性，并且治疗方法，特别是对于位于贲门或食管胃交界（EGJ）处的肿瘤，尚未完全确立。已针对这些病变开发了微创技术，如内镜黏膜下剥离术（ESD）、黏膜下隧道内镜切除术（STER）和腹腔镜楔形切除术（LWR）。然而，关于它们在这些部位的可行性、安全性和临床结果的比较数据仍然有限。
比较ESD、STER和LWR治疗EGJ或贲门处SMTs的效果，重点关注手术可行性。
这项单中心回顾性研究纳入了2014年7月至2022年9月期间接受ESD、STER或LWR治疗的，距固有肌层小于45mm、在EGJ或贲门处向腔内生长的SMTs患者。主要结局是随访期间的无复发生存率。
ESD、STER和LWR患者的中位年龄（四分位间距）分别为53.0（40.0 - 57.5）岁、43.0（39.0 - 57.0）岁和56.0（43.0 - 64.0）岁。中位随访时间（四分位间距）分别为60.0（26.5 - 66.5）个月、24.0（13.0 - 38.0）个月和35.0（21.0 - 60.0）个月。LWR组的肿瘤最大（30.0mm），高危胃肠道间质瘤的发生率最高（68.0%，<0.001）。1例LWR患者出现肿瘤复发（4.0%， = 0.600）。肉眼切除率均为100%（ = 1.000），但显微镜下切除率有所不同（ = 0.021）。5例患者（10.0%）发生了严重的轻微并发症，均为Ⅲa级。肿瘤位置（贲门/胃底， = 0.006）和手术时间延长（<0.001）与并发症显著相关。
ESD、STER和LWR对EGJ和贲门处的SMTs有效，并发症与肿瘤位置和手术时间有关，复发率相当。
