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Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos)

Byline: Xiao-Yun Wang (1,2), Mei-Dong Xu (1), Li-Qing Yao (1), Ping-Hong Zhou (1), Douglas Pleskow (3), Quan-Lin Li (1), Yi-Qun Zhang (1), Wei-Feng Chen (1), Yun-Shi Zhong (1) Keywords: Submucosal tunneling endoscopic resection; Esophagogastric junction; Submucosal tumors Abstract: Background The es... Full description

Journal Title: Surgical Endoscopy 2014, Vol.28(6), pp.1971-1977
Main Author: Wang, Xiao-Yun
Other Authors: Xu, Mei-Dong , Yao, Li-Qing , Zhou, Ping-Hong , Pleskow, Douglas , Li, Quan-Lin , Zhang, Yi-Qun , Chen, Wei-Feng , Zhong, Yun-Shi
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 0930-2794 ; E-ISSN: 1432-2218 ; DOI: 10.1007/s00464-014-3420-2
Link: http://dx.doi.org/10.1007/s00464-014-3420-2
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recordid: springer_jour10.1007/s00464-014-3420-2
title: Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos)
format: Article
creator:
  • Wang, Xiao-Yun
  • Xu, Mei-Dong
  • Yao, Li-Qing
  • Zhou, Ping-Hong
  • Pleskow, Douglas
  • Li, Quan-Lin
  • Zhang, Yi-Qun
  • Chen, Wei-Feng
  • Zhong, Yun-Shi
subjects:
  • Submucosal tunneling endoscopic resection
  • Esophagogastric junction
  • Submucosal tumors
ispartof: Surgical Endoscopy, 2014, Vol.28(6), pp.1971-1977
description: Byline: Xiao-Yun Wang (1,2), Mei-Dong Xu (1), Li-Qing Yao (1), Ping-Hong Zhou (1), Douglas Pleskow (3), Quan-Lin Li (1), Yi-Qun Zhang (1), Wei-Feng Chen (1), Yun-Shi Zhong (1) Keywords: Submucosal tunneling endoscopic resection; Esophagogastric junction; Submucosal tumors Abstract: Background The esophagogastric junction (EGJ) is a difficult location for endoscopic resection due to its narrow lumen and sharp angle. Potential increased risks of perforation and mediastinal infection exist, especially for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. We previously demonstrated the safety and efficacy of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal SMTs, but the feasibility of STER for the removal of SMTs at the EGJ requires systematic investigation. The aim of the investigation was to evaluate the clinical impact of STER on the removal of SMTs at the EGJ. Methods A prospective study was carried out which included a consecutive cohort of 57 patients who underwent STER for 57 SMTs of the EGJ originating from the MP layer between July 2010 and August 2012 in a single academic medical center. Adverse events, en bloc resection rate, and local recurrence were evaluated. Results The average maximum diameter of the lesions was 21.5 mm (range 6--35 mm). The en bloc resection rate was 100 % (57/57). No delayed hemorrhage or severe adverse events occurred in any of the 57 patients following STER. No local recurrence and distant metastasis occurred during 24 months' follow-up. Less subcutaneous emphysema and pneumomediastinum absorption time (p = 0.005) occurred with CO.sub.2 versus air insufflations. Conclusions Our study showed that STER was safe and effective, provided accurate histopathologic evaluation, and was curative for SMTs of the deep MP layers at the EGJ. CO.sub.2 gas insufflation is recommended. Author Affiliation: (1) Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China (2) Department of Gastroenterology, Wuxi Second People's Hospital, Wuxi, Jiangsu, People's Republic of China (3) Division of Gastroenterology, Beth Israel Deaconess Hospital, Boston, MA, USA Article History: Registration Date: 09/01/2014 Received Date: 19/07/2013 Accepted Date: 01/01/2014 Online Date: 11/02/2014 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00464-014-3420-2) contain
language: eng
source:
identifier: ISSN: 0930-2794 ; E-ISSN: 1432-2218 ; DOI: 10.1007/s00464-014-3420-2
fulltext: fulltext
issn:
  • 1432-2218
  • 14322218
  • 0930-2794
  • 09302794
url: Link


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titleSubmucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos)
creatorWang, Xiao-Yun ; Xu, Mei-Dong ; Yao, Li-Qing ; Zhou, Ping-Hong ; Pleskow, Douglas ; Li, Quan-Lin ; Zhang, Yi-Qun ; Chen, Wei-Feng ; Zhong, Yun-Shi
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descriptionByline: Xiao-Yun Wang (1,2), Mei-Dong Xu (1), Li-Qing Yao (1), Ping-Hong Zhou (1), Douglas Pleskow (3), Quan-Lin Li (1), Yi-Qun Zhang (1), Wei-Feng Chen (1), Yun-Shi Zhong (1) Keywords: Submucosal tunneling endoscopic resection; Esophagogastric junction; Submucosal tumors Abstract: Background The esophagogastric junction (EGJ) is a difficult location for endoscopic resection due to its narrow lumen and sharp angle. Potential increased risks of perforation and mediastinal infection exist, especially for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. We previously demonstrated the safety and efficacy of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal SMTs, but the feasibility of STER for the removal of SMTs at the EGJ requires systematic investigation. The aim of the investigation was to evaluate the clinical impact of STER on the removal of SMTs at the EGJ. Methods A prospective study was carried out which included a consecutive cohort of 57 patients who underwent STER for 57 SMTs of the EGJ originating from the MP layer between July 2010 and August 2012 in a single academic medical center. Adverse events, en bloc resection rate, and local recurrence were evaluated. Results The average maximum diameter of the lesions was 21.5 mm (range 6--35 mm). The en bloc resection rate was 100 % (57/57). No delayed hemorrhage or severe adverse events occurred in any of the 57 patients following STER. No local recurrence and distant metastasis occurred during 24 months' follow-up. Less subcutaneous emphysema and pneumomediastinum absorption time (p = 0.005) occurred with CO.sub.2 versus air insufflations. Conclusions Our study showed that STER was safe and effective, provided accurate histopathologic evaluation, and was curative for SMTs of the deep MP layers at the EGJ. CO.sub.2 gas insufflation is recommended. Author Affiliation: (1) Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China (2) Department of Gastroenterology, Wuxi Second People's Hospital, Wuxi, Jiangsu, People's Republic of China (3) Division of Gastroenterology, Beth Israel Deaconess Hospital, Boston, MA, USA Article History: Registration Date: 09/01/2014 Received Date: 19/07/2013 Accepted Date: 01/01/2014 Online Date: 11/02/2014 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00464-014-3420-2) contains supplementary material, which is available to authorized users.
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