Korean J Gastrointest Endosc.  2008 Apr;36(4):193-199.

The Usefulness of Endoscopic Subtumoral Dissection for En-bloc Resection of Upper Gastrointestinal Submucosal Tumor

Affiliations
  • 1Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea. mslee8597@hanmail.net

Abstract

BACKGROUND/AIMS
The removal of esophageal and gastric submucosal tumors is difficult using conventional endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors.
METHODS
An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal tumors (M: F=10 : 5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal dissection.
RESULTS
Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5x21.1 mm. The mean procedure time was 49.4 minutes (range: 8~103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery.
CONCLUSIONS
An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin.

Keyword

Submucosal tumor; Endoscopic subtumoral dissection; En-bloc resection

MeSH Terms

Endosonography
Gastrointestinal Stromal Tumors
Hemangioma
Humans
Leiomyoma
Lipoma
Muscles
Pancreas
Stomach
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