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Clinical data of 43 patients who underwent endoscopic resection for gastrointestinal stromal tumors (GIST) of length ≤1.2 cm at the Digestive Endoscopy Center of the 909th Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients were divided into the endoscopic ligation resection (ELR) group ( n=27) and the endoscopic submucosal excavation (ESE) group ( n=16). The general, perioperative and follow-up data of the two groups were compared. The results showed that there was no significant difference in the general data between the two groups. The operation time was 20.0 (18.0,25.0) min in the ELR group and 27.5 (23.0,37.5) min in the ESE group, showing significant difference ( U=92.5, P=0.001). The en bloc resection rates were 100.0% (27/27) in the ELR group and 81.3% (13/16) in the ESE group, showing significant difference ( P=0.045). The postoperative hospital stays were 3 (2,4) days in the ELR group and 5 (4,6) days in the ESE group, showing significant difference ( U=125.5, P=0.020). There was no significant difference in the intraoperative bleeding rate, intraoperative hemorrhage volume, intraoperative perforation rate, number of hemostatic clips or postoperative complications including hemorrhage, fever and peritonitis between the two groups ( P>0.05). During the follow-up, there was no recurrence or metastasis of GIST in both groups. ELR and ESE can be safe and effective for small GIST ≤1.2 cm in diameter. Compared with the ESE group, the operation time and postoperative hospital stay are shorter with higher en bloc resection rate in the ELR group.
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Objective:To compare the efficacy and safety of endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFR) for intraluminal gastric stromal tumors.Methods:Data of 441 patients diagnosed as having gastric stromal tumors in Nanjing Drum Tower Hospital from June 2009 to June 2020 were retrospectively analyzed. A total of 241 patients underwent ESE (ESE group) and 200 EFR (EFR group). Epidemiological data (gender, age and body mass index), tumor size, procedure related parameters, complications, hospital stay, cost and follow-up were compared between the two groups.Results:There were no significant differences between the two groups in gender, age, body mass index, tumor size, National Institutes of Health risk grade, complete resection rate, or block resection rate ( P>0.05). Compared with the EFR group, the ESE group required less titanium clips to close defects in the stomach wall [6.0 (4.0, 6.0) VS 6.0 (5.0, 8.0), U=18 424.0. P<0.001], shorter time of first postoperative fluid intake [2.0 (1.0, 2.0) days VS 2.0 (2.0, 3.0) days, U=17 420.0, P<0.001] and hospital stay [6.0 (5.0, 8.0) days VS 7.0 (6.0, 9.0) days, U=18 906.0, P<0.001], and lower total cost [18.9 (16.4, 21.4) thousand yuan VS 20.9 (18.1, 23.8) thousand yuan, U=17 956.0, P<0.001]. Moreover, the total incidence of complications of the ESE group was lower than that of the EFR group [5.8% (14/241) VS 11.5% (23/200), χ2=4.605, P=0.032]. Patients were followed up with the median period of 45.0 months. The disease recurrence rate was 0.45% (2/441), and there were no disease-related deaths. Conclusion:The efficacy is comparable between ESE and EFR for treating intraluminal gastric stromal tumors, but ESE shows a lower incidence of complications, and requires a shorter hospital stay and lower cost.
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Background: There are a variety of endoscopic techniques for treatment of gastrointestinal submucosal tumors (SMTs). However, because of the difficulties in operation, high technique needs of operator and long period of training needed, some of these techniques could not be promoted and implemented in primary hospitals. Aims: To evaluate the feasibility and safety of endoscopic submucosal excavation assisted with ligation device (ESE-LD) for treatment of small gastrointestinal SMTs. Methods: The clinical data of 75 patients who underwent ESE-LD during January 2014 to July 2019 at the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine and Jinling Hospital for treatment of small gastrointestinal SMTs (<2 cm in diameter) were retrospectively collected and analyzed. Results: In the 75 small gastrointestinal SMTs, 42 were originated from submucosa and 33 from muscularis propria. Eighteen lesions were located in esophagus, 30 in stomach, 6 in duodenum and 21 in colorectum. All tumors (mean diameter: 13 mm±3 mm, range: 0.5-2 cm) achieved en bloc resection. The mean time of ESE-LD procedure was (16.7±3.2) min, and the mean time of hospitalization was (5.08±1.21) d. No delayed bleeding and perforation requiring further intervention occurred. There were no recurrences during the follow-up period of (33.8±5.2) months. Conclusions: ESE-LD is safe and effective for treatment of gastrointestinal SMTs less than 2 cm in diameter. Moreover, it is easy to operate with short operation time. ESE-LD might be recommended to be promoted in primary hospitals.
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Objective To investigate the therapeutic effect and safety of ESE (endoscopic submucosalexcavation) as the derivative technology of ESD (endoscopic submucosal dissection) for intestinal Neuroendocrinetumor. Methods A total of 23 lesions diagnosed as Neuroendocrine tumor were treated by ESE. Pathologicaldiagnosis was performed. Reverse events were recorded.Patients were followed up for recurrence andmetastasis. Results Lesions, 0.4 ~ 3.0 cm (medium size 1.0 cm) in diameter,were all resected at one ESE procedure.The operation time was 20 ~ 75 min (medium 30 min). Postoperative bleeding occurred in one case .Initiative fullthickness resection was made in one case due to the violation of muscularis propria layer. 23 cases were histologicallydiagnosed as neuroendocrine tumor, with 21 as G1 and 2 as G2, none as G3. Within 3 gastric neuroendocrine tumors,2 were type 1 and 1 was type 2. All resected samples were free of residual tumor cell in the lateral and basalmargins. Conclusion ESE is safe and efficacious for the treatment of intestinal neuroendocrine tumor.
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Objective To evaluate the efficacy and safety of endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) for gastroesophageal junction (GEJ)submucosal tumors (SMTs) originating from the muscularis propria(MP) layer.Methods Clinical data of sixty-one patients with GEJ SMTs originating from the MP layer who were treated with ESE(ESE group,n=39) or STER(STER group,n=22) between January 2013 and December 2015 in Changhai Hospital were retrospectively analyzed.Outcomes and complications in the two groups were compared.Results Single lesion in 61 patients were all resected by therapeutic endoscopy successfully.Operation time in the STER group was shorter than that of the ESE group(47.27±20.89 min VS 66.56±40.07 min,P＜0.05).There was no significant difference in number of hemostatic clips between the two groups[7.10±5.57 VS 8.00± 1.88,P＞0.05].Hospitalization time of STER group was shorter than that of the ESE group [3.0(1.25) d VS 4.0 (1.00) d,P＜0.05].One patient developed delayed hemorrhage in ESE group,while no other complications occurred in either group.The wound healed in both groups under gastroscopy,and no residual or recurrent tumors were detected during the follow-up period.Conclusion Both STER and ESE can be used for GEJ SMTs originating from the MP layer,but STER is more safe and efficient.
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Objective To study the value of endoscopic submucosal excavation (ESE) for esophageal submucosal tumors originating from the muscularis propria layer.Methods Data of 27 patients with 29 lesions in esophageal muscularis propria treated with ESE from Dec.2008 to Dec.2010 were retrospected.Feasibility,effects and safety were evaluated accordingly.Results Of 27 patients,there were 17 males and 10 females.Mean age was 50(22 ～62)yrs,and mean diameter of the lesions was 1.25 ±0.70 (0.5 ～3.0)cm.Resection rate was 96.3％ (26/27).One failed case with tumor residual after ESE received additional operation.The median procedure time was 74 (30-120) min.Pathological examination confirmed leiomyoma in 26 cases and gastrointestinal stromal tumor (GISTs) in 1 case.Perforation during operation occurred in 2 cases,accompanied with pneumothorax.They were treated with closed thoracic drainage,without surgery.The median follow-up time was 12 months (3 to 27 months),and no recurrence was found.Conclusion ESE is a safe and effective therapy for the esophageal tumor smaller than 3.0 cm from the muscularis propria.