Clin Endosc.  2018 Jan;51(1):19-27. 10.5946/ce.2018.020.

Endoscopic Treatment of Subepithelial Tumors

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea. kkoimge@naver.com

Abstract

Gastrointestinal subepithelial tumors (SETs) are generally found during endoscopy and their incidence has gradually increased. Although the indications for the endoscopic treatment of patients with SETs remain to be established, the feasibility and safety of endoscopic dissection, including the advantages of this method compared with surgical treatment, have been validated in many studies. The development of endoscopic techniques, such as endoscopic submucosal dissection, endoscopic enucleation, endoscopic excavation, endoscopic submucosal tunnel dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection has enabled the removal of SETs while reducing the occurrence of complications. Here, we discuss the endoscopic treatment of patients with SETs, outcomes for endoscopic treatment, and procedure-related complications. We also consider the advantages and disadvantages of the various endoscopic techniques.

Keyword

Endoscopic resection; Gastrointestinal tract; Subepithelial tumor

MeSH Terms

Endoscopy
Gastrointestinal Tract
Humans
Incidence
Methods

Figure

  • Fig. 1. Endoscopic submucosal dissection of a gastrointestinal stromal tumor. (A) A large subepithelial tumor is observed at the high body of the stomach. (B, C) Circumferential incision and submucosal dissection of the tumor is performed. (D) Most of the subepithelial tumor is exposed to the lumen. (E) A post-endoscopic submucosal dissection ulcer is observed. (F) The resected specimen (tumor size is 2.4 cm).

  • Fig. 2. Endoscopic excavation with clipping of a gastrointestinal stromal tumor. (A) A large and round subepithelial tumor is found at the high body of the stomach. (BD) After the mucosa overlying the lesion is cut, the subepithelial tumor is excavated from the muscularis propria layer. (E) The wound is closed endoscopic clips. (F) The resected specimen (tumor size is 2.0 cm).


Cited by  2 articles

Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria
Ah Lon Jung, Sang Wook Park, Gun Young Hong, Hyeong Chul Moon, Seo Joon Eun
Clin Endosc. 2021;54(1):131-135.    doi: 10.5946/ce.2020.070.

Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions
Hung Leng Kaan, Khek Yu Ho
Clin Endosc. 2020;53(5):541-549.    doi: 10.5946/ce.2019.161.


Reference

1. Ponsaing LG, Hansen MB. Therapeutic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol. 2007; 13:3316–3322.
Article
2. Chun SY, Kim KO, Park DS, et al. Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: a preliminary analysis of appropriate indications. Surg Endosc. 2013; 27:3271–3279.
Article
3. He Z, Sun C, Wang J, et al. Efficacy and safety of endoscopic submucosal dissection in treating gastric subepithelial tumors originating in the muscularis propria layer: a single-center study of 144 cases. Scand J Gastroenterol. 2013; 48:1466–1473.
Article
4. Bialek A, Wiechowska-Kozłowska A, Pertkiewicz J, et al. Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc. 2012; 75:276–286.
5. Schmidt A, Bauder M, Riecken B, von Renteln D, Muehleisen H, Caca K. Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series. Endoscopy. 2015; 47:154–158.
Article
6. Kim SY, Kim KO. Management of gastric subepithelial tumors: the role of endoscopy. World J Gastrointest Endosc. 2016; 8:418–424.
Article
7. Wong VWY, Goto O, Gregersen H, Chiu PWY. Endoscopic treatment of subepithelial lesions of the gastrointestinal tract. Curr Treat Options Gastroenterol. 2017; 15:603–617.
Article
8. Zhang Y, Ye LP, Mao XL. Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer. World J Gastroenterol. 2015; 21:9503–9511.
Article
9. Yu JP, Luo HS, Wang XZ. Endoscopic treatment of submucosal lesions of the gastrointestinal tract. Endoscopy. 1992; 24:190–193.
Article
10. Kojima T, Takahashi H, Parra-Blanco A, Kohsen K, Fujita R. Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection. Gastrointest Endosc. 1999; 50:516–522.
Article
11. Kim GH. Endoscopic resection of subepithelial tumors. Clin Endosc. 2012; 45:240–244.
Article
12. Lee DG, Kim GH, Park DY, et al. Endoscopic submucosal resection of esophageal subepithelial lesions using band ligation. Endoscopy. 2011; 43:822–825.
Article
13. Kajiyama T, Sakai M, Torii A, et al. Endoscopic aspiration lumpectomy of esophageal leiomyomas derived from the muscularis mucosae. Am J Gastroenterol. 1995; 90:417–422.
14. Chung IK, Lee JH, Lee S-H, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD study group multicenter study. Gastrointest Endosc. 2009; 69:1228–1235.
Article
15. Lee IL, Lin PY, Tung SY, Shen CH, Wei KL, Wu CS. Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy. 2006; 38:1024–1028.
Article
16. Liu BR, Song JT, Qu B, Wen JF, Yin JB, Liu W. Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria. Surg Endosc. 2012; 26:3141–3148.
Article
17. Ye LP, Zhu LH, Zhou XB, Mao XL, Zhang Y. Endoscopic excavation for the treatment of small esophageal subepithelial tumors originating from the muscularis propria. Hepatogastroenterology. 2015; 62:65–68.
18. Jeong ID, Jung SW, Bang SJ, Shin JW, Park NH, Kim DH. Endoscopic enucleation for gastric subepithelial tumors originating in the muscularis propria layer. Surg Endosc. 2011; 25:468–474.
Article
19. Chu YY, Lien JM, Tsai MH, et al. Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer. BMC Gastroenterol. 2012; 12:124.
Article
20. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010; 42:265–271.
Article
21. Hoteya S, Iizuka T, Kikuchi D, Yahagi N. Endoscopic submucosal dissection for gastric submucosal tumor, endoscopic sub-tumoral dissection. Dig Endosc. 2009; 21:266–269.
Article
22. Li L, Wang F, Wu B, Wang Q, Wang C, Liu J. Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria. Exp Ther Med. 2013; 6:391–395.
Article
23. Zhang Y, Ye LP, Zhou XB, et al. Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer: results from a large study in China. J Clin Gastroenterol. 2013; 47:689–694.
24. Catalano F, Rodella L, Lombardo F, et al. Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study. Gastric Cancer. 2013; 16:563–570.
Article
25. Inoue H, Ikeda H, Hosoya T, et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy. 2012; 44:225–230.
Article
26. Gong W, Xiong Y, Zhi F, Liu S, Wang A, Jiang B. Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors. Endoscopy. 2012; 44:231–235.
Article
27. Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou X, Chen JY. Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc. 2014; 28:524–530.
Article
28. Zhou DJ, Dai ZB, Wells MM, Yu DL, Zhang J, Zhang L. Submucosal tunneling and endoscopic resection of submucosal tumors at the esophagogastric junction. World J Gastroenterol. 2015; 21:578–583.
Article
29. Li QL, Chen WF, Zhang C, et al. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc. 2015; 29:3640–3646.
Article
30. Chen T, Zhou PH, Chu Y, et al. Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg. 2017; 265:363–369.
Article
31. Zhou PH, Yao LQ, Qin XY, et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc. 2011; 25:2926–2931.
Article
32. Ye LP, Yu Z, Mao XL, Zhu LH, Zhou XB. Endoscopic full-thickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc. 2014; 28:1978–1983.
Article
33. Xu MD, Cai MY, Zhou PH, et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc. 2012; 75:195–199.
Article
34. Liu BR, Song JT, Kong LJ, Pei FH, Wang XH, Du YJ. Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia. Surg Endosc. 2013; 27:4354–4359.
Article
35. Wang XY, Xu MD, Yao LQ, et al. Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos). Surg Endosc. 2014; 28:1971–1977.
Article
36. Lu J, Zheng M, Jiao T, Wang Y, Lu X. Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy. 2014; 46:888–892.
Article
37. Wang H, Tan Y, Zhou Y, et al. Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol. 2015; 27:776–780.
Article
38. Guo J, Liu Z, Sun S, et al. Endoscopic full-thickness resection with defect closure using an over-the-scope clip for gastric subepithelial tumors originating from the muscularis propria. Surg Endosc. 2015; 29:3356–3362.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr