Background and Aims

The management of subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors can be challenging and traditionally requires a surgical resection that is not only invasive but may carry a significant risk of morbidity and mortality. We aimed to assess the feasibility, safety, and efficacy of a novel endoscopic technique termed submucosal tunnel endoscopic resection for extraluminal tumors (STER-ET).

Methods

We prospectively enrolled patients who underwent STER-ET for GI subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors located at the level of cardia or the proximal part of the lesser curvature of the stomach seen on cross-sectional imaging between January 2016 and March 2017.

Results

Eight patients underwent STER-ET. The mean (± standard deviation) tumor size was 2.8 ± 0.6 cm and 2.3 ± 0.8 cm in longest and shortest dimension, respectively. The average procedure time was 67 ± 4.4 minutes. The rates of curative en bloc resection and en bloc retrieval was 100% and 87.5%, respectively. On final histology, 6 tumors were GI stromal tumors, 1 was a schwannoma, and 1 was a foregut cyst. Five patients had capnoperitoneum during the procedure and required abdominal decompression. One patient had a small mucosotomy successfully treated with a hemostatic clip. There were no major adverse events or deaths. The median length of hospital stay was 3 days. There was no residual tumor on surveillance imaging after a mean follow-up period of 10.0 ± 2.1 months.

Conclusions

STER-ET is a novel technique that appears to be safe and effective in achieving a curative resection for GI subepithelial tumors with a predominantly extraluminal growth pattern or extraluminal tumors in a selected group of patients. However, larger studies are required to validate our finding.

中文翻译：

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腔内肿瘤的粘膜下隧道内窥镜切除术：一种主要的腔内生长性上皮下肿瘤或胃肠道外肿瘤整体切除术的新型内窥镜检查方法（带视频）

背景和目标

具有显着的腔外生长模式或上消化道肿瘤的上皮下肿瘤的治疗可能具有挑战性，并且传统上需要外科手术切除，这不仅是侵入性的，而且可能具有很高的发病率和死亡率风险。我们的目的是评估一种称为腔内肿瘤的粘膜下隧道内镜切除术（STER-ET）的新型内镜技术的可行性，安全性和有效性。

方法

我们对2016年1月间在横截面显像中发现有STER-ET的GI上皮样上皮下肿瘤，主要是管腔外生长模式或位于胃肠外水平或胃小弯的近端的胃肠上皮下肿瘤的患者进行了前瞻性入组和2017年3月。

结果

八名患者接受了STER-ET。最长和最短尺寸的平均肿瘤大小（±标准差）分别为2.8±0.6 cm和2.3±0.8 cm。平均手术时间为67±4.4分钟。整体切除和整体取出的治愈率分别为100％和87.5％。在最终的组织学上，6个肿瘤是胃肠道间质瘤，1个是神经鞘瘤，1个是前肠囊肿。五例患者在手术过程中发生了腹膜炎，需要进行腹部减压。一名患者已使用止血夹成功治疗了小的粘膜切开术。没有重大不良事件或死亡。住院时间的中位数为3天。在10.0±2.1个月的平均随访期后，在监视影像学上没有残留肿瘤。

结论

STER-ET是一种新颖的技术，在选定的一组患者中，对于以腔外生长方式为主或腔外肿瘤为主的胃肠上皮下肿瘤，治愈性切除似乎是安全有效的。但是，需要更大的研究来验证我们的发现。