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@#Gastric adenocarcinoma presenting as a submucosal tumor (SMT) accounts to only 0.1% to 0.63%. A 56-year-old Filipino male presenting with new onset melena underwent magnifying endoscopy, narrow-band imaging, endoscopic ultrasound, and computed tomography revealing a 2.5 cm x 2.0 cm polypoid SMT-like lesion at the fundus. Total gastrectomy with lymph node dissection and esophagojejunostomy was performed with histopathology showing adenocarcinoma. This suggests the need for different modalities to ensure the accuracy of diagnosis and the need for subsequent invasive treatments.
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Objective:To explore the clinical characteristics of superficial neoplasia associated with submucosal tumor (SMT) located at the same position and the efficacy of endoscopic super minimally invasive surgery (SMIS).Methods:Data of 9 patients who were diagnosed as having superficial neoplasia associated with SMT at the same position in the upper digestive tract and treated with digestive endoscopic SMIS at the First Medical Center of PLA General Hospital from January 2011 to December 2021 were retrospectively analyzed. Data including basic information, endoscopic diagnosis and treatment, pathological results and follow-up of these patients were collected to analyze their clinicopathological characteristics. The postoperative pathology and incidence of complications were used as the gold standard to assess the effectiveness and safety of SMIS.Results:In the 9 patients, there were 8 males and 1 female with mean age of 61.6±11.7 years. The main symptoms were abdominal pain in 3 cases, abdominal discomfort in 2 cases, and dysphagia in 1 case. Seven patients were diagnosed as having superficial neoplasia before surgery, while SMT was found during surgery. One patient with superficial neoplasia associated with SMT and 1 with SMT were diagnosed before the surgery. The common sites of the lesion were esophagus (3 cases), gastric antrum (3 cases), cardia (2 cases) and fundus (1 case). The Paris classification of all lesions was type Ⅰ, Ⅱa or combinations. The most common pathological type was early cancer with leiomyoma in 5 cases. All lesions met the criteria of en bloc resection. One lesion had positive lateral margin with low-grade intraepithelial neoplasia, four were all completely resected. No complications such as bleeding, perforation or infection occurred in this study. Follow-up date were available in all cases with a mean period of 19-81 months and no recurrence or metastasis was discovered.Conclusion:The symptoms of patients with superficial neoplasia associated with SMT located at the same position are often atypical. The endoscopic type of lesions is usually protrusion or partial protrusion. Most are diagnosed as having superficial neoplasia before the surgery, and SMT are usually found coincidentally. The most common pathological type is early cancer with leiomyoma. SMIS is safe and effective for the complex lesion.
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Objective:To evaluate the efficacy and safety of non-submucosal injection in endoscopic submucosal excavation (ESE) for small submucosal tumors originating in the muscularis propria of the stomach.Methods:A total of 138 patients diagnosed as having small gastric muscularis propria tumors (≤2 cm) at Digestive Endoscopy Center of Zhejiang Provincial Hospital of Chinese Medical from November 2018 to October 2020 were randomly divided into the observation group with non-submucosal injection of ESE and the control group with submucosal injection of ESE for a randomized controlled trial. The exposure time, tumor removal time, operation cost, hospitalization period, numbers of metal clips and complications of the two groups were analyzed and compared.Results:A total of 138 patients were enrolled, including 76 patients in the observation group and 62 patients in the control group. All lesions were successfully and completely removed. Compared with the control group, the observation group had shorter median tumor exposure time [2.00 min VS 3.30 min, Z=-2.426, P =0.045], shorter median tumor removal time [16.8 min VS 34.4 min, Z=-4.324, P<0.001], less median surgical cost [2 903 yuan VS 3 178 yuan, Z=-5.112, P<0.001], and fewer metal clips used (4.0±0.6 VS 5.1±1.3, t=1.452, P=0.003). The incidence of postoperative abdominal distension of the observation group was lower [9.2% (7/76) VS 22.6% (14/62), χ2=2.512, P=0.049], the incidence of postoperative abdominal pain of this group was lower too [11.8% (9/76) VS 32.3% (20/62), χ2=4.242, P=0.014], but there was no significant difference in the period of hospitalization, incidence of postoperative fever or perforation ( P>0.05). Conclusion:Non-submucosal injection of ESE is safe and effective for submucosal tumors smaller than 2.0 cm originating from the muscularis propria of the stomach , which might be more advantageous than traditional ESE.
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Objective To explore the efficacy and safety of endoscopic ligation in treatment of gastric submucosal tumors(diameter≤1 cm).Methods Clinical data of 177 patients with gastric submucosal tumors who received endoscopic therapy from October 2020 to July 2022 were retrospectively analyzed.Patients were divided into endoscopic submucosal dissection(ESD)group(n = 142)and endoscopic ligation group(n = 35)according to different endoscopic treatment methods,and the operation time,intraoperative complications,postoperative hospital stay,surgical cost,complete lesion resection,postoperative complications and pathology of the two groups were compared.Results The operative time of the ESD group was(33.23±8.55)min,which was significantly longer than that of the endoscopic ligation group(24.85±5.96)min.The intraoperative bleeding was ERB-c1 and no ERB-c2 of the ESD group,which was better than that of the endoscopic ligation group,and the operative cost was(24 615.08±5 678.32)yuan,significantly more than that of the endoscopic ligation group(21 319.26±7 235.95)yuan,the differences were statistically significant(P＜0.05).There was no significant difference in the intraoperative perforation rate,postoperative hospitalization time and postoperative follow-up time between the two groups(P＞0.05).No surgical transfer,serious infection,delayed hemorrhage and perioperative death occurred in both groups,and no tumor recurrence,metastasis and death were found.Conclusion Endoscopic ligation has the advantages of relatively safe,efficient,less blood loss and low cost,but it has the risk of bleeding which is difficult to predict.Therefore,it is particularly important to select appropriate treatment after adequate evaluation.
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Objective:To construct a deep learning-based diagnostic system for gastrointestinal submucosal tumor (SMT) under endoscopic ultrasonography (EUS), so as to help endoscopists diagnose SMT.Methods:From January 1, 2019 to December 15, 2021, at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University, 245 patients with SMT confirmed by pathological diagnosis who underwent EUS and endoscopic submucosal dissection were enrolled. A total of 3 400 EUS images were collected. Among the images, 2 722 EUS images were used for training of lesion segmentation model, while 2 209 EUS images were used for training of stromal tumor and leiomyoma classification model; 283 and 191 images were selected as independent test sets to evaluate lesion segmentation model and classification model, respectively. Thirty images were selected as an independent data set for human-machine competition to compare the lesion classification accuracy between lesion classification models and 6 endoscopists. The performance of the segmentation model was evaluated by indexes such as Intersection-over-Union and Dice coefficient. The performance of the classification model was evaluated by accuracy. Chi-square test was used for statistical analysis.Results:The average Intersection-over-Union and Dice coefficient of lesion segmentation model were 0.754 and 0.835, respectively, and the accuracy, recall and F1 score were 95.2%, 98.9% and 97.0%, respectively. Based on the lesion segmentation, the accuracy of classification model increased from 70.2% to 92.1%. The results of human-machine competition showed that the accuracy of classification model in differential diagnosis of stromal tumor and leiomyoma was 86.7% (26/30), which was superior to that of 4 out of the 6 endoscopists(56.7%, 17/30; 56.7%, 17/30; 53.3%, 16/30; 60.0%, 18/30; respectively), and the differences were statistically significant( χ2=7.11, 7.36, 8.10, 6.13; all P<0.05). There was no significant difference between the accuracy of the other 2 endoscopists(76.7%, 23/30; 73.3%, 22/30; respectively) and model(both P<0.05). Conclusion:This system could be used for the auxiliary diagnosis of SMT under ultrasonic endoscope in the future, and to provide a powerful evidence for the selection of subsequent treatment decisions.
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Objective To investigate whether assessment of the tumor origin and histological features through endoscopic ultrasonography could improve the operative efficacy of endoscopic resection of esophageal leiomyoma. Methods The clinical data of patients with esophageal submucosal tumor who were treated in our department and diagnosed as leiomyoma pathologically from January 2016 to June 2020 was retrospectively analyzed. A total of 58 patients with esophageal leiomyoma underwent endoscopic resection following evaluation of endoscopic ultrasonography. The en bloc resection rate, operation time, hospitalization day, and complications were evaluated. Results Preoperative endoscopic ultrasonography showed that leiomyoma originated from muscularis mucosa in 39 cases and muscularis propria in 19 cases. The mean tumor size was 1.50 (0.2-6.5) cm, and 20 cases underwent endoscopic mucosal resection (EMR), 32 cases underwent endoscopic submucosal excavation (ESE), and 6 cases underwent submucosal tunneling endoscopic resection (STER). The overall en bloc rate was 96.6%. The mean operation time was 38.29 (15-100) min. The postoperative complication rate was 15.5% (9/58), and all were recovered after conservative treatment. Among the 39 cases originated from the muscularis mucosa, 20 cases underwent EMR and 19 cases underwent ESE. There were no significant differences in tumor size and complications between the two groups, but the operative time and the length of postoperative hospitalization in the EMR group were significantly shorter (P < 0.05). Among the 19 patients originated from the muscularis propria, 13 cases underwent ESE and 6 cases underwent STER. There were no significant differences in tumor size, operative time, the length of postoperative hospitalization and complications between the two groups. Conclusion Preoperastive endoscopic ultrasonography could precisely detect the origin and histology characteristics of esophageal leiomyoma and improves the operation effect.
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Objective: To analyze the clinicopathological and biological characteristics of esophageal submucosal tumors (SMTs) and to investigate the safety and efficacy of endoscopic resection for esophageal SMTs. Methods: We retrospectively analyzed the data of 152 cases of esophageal submucosal tumors resected by endoscopy in Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, from February 2013 to June 2018 as well as the pathological properties, distribution characteristics, origin and location of the esophageal SMTs. We also analyzed complications and efficacy of different methods for endoscopic resection. Results: The average age of onset of esophageal SMTs in this group was 52.74±10.53 years, without gender difference. Pathological features were as follows: leiomyoma was more common (73.68%), followed by stromal tumor (11.18%), hemangioma (3.95%), cyst (3.29%), and lipoma (1.97%). SMTs occurred mostly in the middle and lower segments of the esophagus. They were mainly located in the muscularis mucosa (31.58%) and muscularis propria (57.89%), and partly located in the submucosa (10.53%). Endoscopic resection methods consisted of endoscopic mucosal resection (EMR) performed in 36 cases, endoscopic submucosal dissection (ESD) in 52 cases, submucosal tunneling endoscopic resection (STER) in 63 cases, and full-thickness resection (EFTR) in 1 case. All lesions were completely resected. EMR had small tumor resection and shorter operative time; ESD and STER showed large tumor resection and long operation time (P0.05). Complications were effectively controlled. No local recurrence or residual cases were found in postoperative follow-up. Conclusion: Adult onset of submucosal tumors of the esophagus, without gender difference, can occur in all segments of the esophagus, mostly from the mucosal muscularis and muscularis propria. Leiomyoma is common, followed by stromal tumor, spindle cell tumor, and hemangioma. Endoscopic resection depends on the lesion location, source and size, and endoscopic treatment is safe and effective.
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Objective To investigate the efficacy and limitation of endoscopic ultrasonography (EUS) on the diagnosis of gastrointestinal submucosal tumor (SMT) prior to endoscopic resection.Methods Data of 211 patients,who were confirmed as gastrointestinal SMT before operation and received endoscopic resection for gastrointestinal submucosal tumor at Department of Gastroenterology,Shanghai Ruijin Hospital from January 2016 to December 2018 were analyzed.The value and limitation of EUS for SMT were investigated according to the final pathology.Results For the lesion distribution,66 were in esophagus,108 in stomach,2 in duodenum and 35 in rectum.The accuracy of tumor origin by EUS was 99.5％ (210/211).The accuracy of tumor nature by EUS was 75.8％ (160/211).For the lesions originated from different locations,the diagnostic accuracy for lesion originated from esophageal mucosa/submucosa,esophageal muscularis propria,gastric mucosa/submucosa,gastric muscularis propria,duodenal submucosa,rectal mucosa/submucosa by EUS were 90.0％ (54/60),83.3％ (5/6),31.0％ (13/42),89.4％ (59/66),50.0％(1/2),82.9％ (29/35),respectively.With respect to hypoechoic lesions,leiomyoma,leiomyoma/gastrointestinal stromal tumor,and neuroendocrine tumor were the predominant type of tumor originated from esophageal mucosa,gastrointestinal muscularis propria and rectal mucosa/submucosal,respectively.Conclusion Although EUS is indispensible for the diagnosis of gastrointestinal submucosal tumor,it plays a limited role in the differential diagnosis of various lesions originated from gastric mucosa and submucosa.Since part of the submucosal tumors may be potential for malignant development,an diagnosis made by EUS should be more careful.
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Objective To explore the therapeutic effect and safety of endoscopic multi-band mucosetomy (EMBM) and endoscopic submucosal dissection(ESD) for colorectal submucosal tumors under the guidance of ultrasound endoscopy. Methods From January 2013 to June 2016,the clinical data of sixty patients with colorectal submucosal tumors in Center People's Hospital of Tengzhou who received either EMBM (32 cases) or ESD ( 28 cases) were included in this retrospective study. The complete resection rate, average diameter of resection lesion, operative time, complications and recurrence rate of two groups were compared. Results The complete resection rate of EMBM groups was 96. 9%(31/ 32),the complete resection rate of ESD groups was 96. 4%(27/ 28),there was no statistically significant difference between the two groups (χ2 = 0. 07,P= 0. 812). The average diameter of was ESD group (12. 3±2. 6) mm,significantly greater than that of EMBM group ((9. 1± 2. 2) mm) (P = 0. 038),and the mean operation time of EMBM group was (20. 5 ±5. 1) min,which was significantly less than that of ESD group ( (36. 8±4. 5) min) (P = 0. 008),and the percentage of perforation in EMBM group was 0,significantly lower than that of ESD group (10. 7%(3/ 28))(χ2 = 6. 37, P = 0. 013). The severe bleeding rate of EMBM group was 3. 1% (1/ 32),which was significantly lower than that in ESD group(14. 3%(4/ 28)) (χ2 = 4. 89, P = 0. 021) . After 6-12 months of follow-up,no recurrence or distant metastasis was found in EMBM or ESD group. Conclusion EMBM and ESD are safe and effective for colorectal submucosal tumors,However the average diameter of the lesion was larger in EMBM group than that in ESD group.
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Objective To investigate the clinical efficacy and application value of submucosal tunneling endoscopic resection(STER)for upper gastrointestinal submucosal tumors(SMTs). Methods A retrospective analysis was performed on the endoscopic and clinical data of 44 cases with SMTs who received STER from January 2015 to June 2016 in Chinese PLA General Hospital. Results The rate of complete resection was 88.6%(39/44). The operating time was 60.1±30.6 min. The hospitalization time was 10.1± 3.3 days. The rate of complications was 6.8%(3/44). The diagnosis of SMTs by pathology and endoscopic ultrasonography(EUS),the size of SMTs measured by EUS and ruler after STER,and the growing direction judged by EUS and CT were consistent. Conclusion STER for SMTs has a higher complete resection rate, shorter operating time and hospitalization time, and fewer complications. EUS combined with CT is an effective method for preoperative evaluation.
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Objective To explore the clinical value of dental floss traction-assisted endoscopic full-thickness resection ( EFTR) for muscularis propria tumor in gastric fundus. Methods Twenty-four patients with muscularis propria tumor in gastric fundus and undergoing EFTR with traction of dental floss from January to December in 2016 in Endoscopy Center of Zhongshan Hospital were enrolled in the trial group. Another 24 patients undergoing traditional EFTR from January to December in 2015 were enrolled in the control group. The control group was paired with the trial group according to tumor size. The differences in tumor resection time, hospitalization time, and complication rate were compared between the two groups. Results There were no significant differences in the mean age and gender composition between the two groups ( both P>0. 05) . The tumor resection time of the trial group was shorter than that of the control group ( 10. 8 ± 2. 8 min VS 19. 0 ± 4. 7 min, t = 7. 298, P<0. 05 ) . There was no significant difference in postoperative hospital stay between the two groups ( 3. 2 ± 0. 5 days VS 3. 2 ± 0. 5 days, t=0. 291, P=0. 772) . No postoperative delayed bleeding or perforation and other complications occurred in the two groups. Conclusion Dental floss traction-assisted EFTR is safe and effective to treatment of muscularis propria tumors in gastric fundus, which can expose the tumor boundary, so that the surgical level may be clearer to simplify the operation and reduce the tumor resection time.
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Resumen Introducción Los tumores submucosos del tracto gastrointestinal alto tienen potencial de malignidad y también pueden ser una carga para el paciente, por lo que se requiere disponer de un tratamiento seguro y eficaz. El surgimiento de la técnica de resección endoscópica por tunelización submucosa (STER) en los últimos años ha mostrado resultados prometedores. Caso clínico Se presenta el caso de un hombre de 47 años asintomático, en quien, en el contexto de un estudio preoperatorio de cirugía bariátrica, se pesquisa una lesión subepitelial en la unión gastroesofágica. La endosonografía alta es compatible con un leiomioma esofágico. Se realiza STER con éxito y sin complicaciones; a las 48 h es dado de alta. El estudio histopatológico confirmó un leiomioma esofágico. Discusión La técnica STER ha demostrado consistentemente ser segura y eficaz en el tratamiento de los tumores submucosos de la unión gastroesofágica. El desafío es difundir la técnica por el resto del país, para mayor beneficio de los pacientes.
Introduction Upper gastrointestinal submucosal tumors are potentially malignant lesions; so safe and efficient treatments are needed. In recent years, submucosal tunneling endoscopic resection (STER) has emerged as a novel therapeutic technique, with promising results. Case report 47-year-old male patient, previously asymptomatic, who was found to have a subepithelial lesion at the gastroesophageal junction. Upper endoscopic ultrasound was compatible with a leiomyoma. He underwent STER to remove the tumor and recovered with any complications. The biopsy confirmed an esophageal leiomyoma. Discussion STER has become a highly feasible and safe therapeutic option for submucosal tumors of the gastroesophageal junction. The challenge is to spread knowledge about this technique, to maximize patient's benefit.
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Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Esofágicas/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Leiomioma/cirurgia , Resultado do Tratamento , Mucosa/cirurgiaRESUMO
Objective To investigate the spatio-temporal characteristics of normal gastric electrical activity.Methods From January 1st to February 29th,2016,fasting gastric electric slow wave signal was collected by high resolution mapping (HRM) under anesthesia before operation in patients without gastric lesions but needed laparoscopic surgery.Parameters of slow wave signal activity was calculated,gastric activity map and velocities was drawn and then spatio-temporal characteristics of gastric electrical activity of different part of the stomach were obtained.Independent sample t test was performed for comparison of two groups and one-way analysis of variance was used for multiple group comparisons.Results The normal gastric pacing zone located in the upper middle part of gastric body near greater curvature.Electrical activity of gastric body spread to gastric antrum along the long axis of the stomach.No slow signal was recorded in the gastric fundus and the gastric cardia.The frequencies of slow waves of different parts of gastric was same and the mean value was 2.61 ±0.11 cycle per minute.Compared with that of gastric body,the slow wave amplitude of gastric pacing zone was higher ((4.19±0.73) mV vs (1.67± 0.89) mV) and the speed was faster (7.24± 1.37) mm/s vs (4.94± 0.20) mm/s);the differences were statistically significant (t=18.89 and 4.95,both P＜0.01).The slow wave amplitude of gastric antrum was higher than that of gastric body ((3.21±0.49) mV vs (1.67±0.89) mV) and the speed was also faster ((6.44±0.82) mm/s vs (4.94±0.20) mm/s);the differences were statistically significant (t=4.85 and 4.95,both P＜0.05).The slow wave amplitude of gastric antrum was lower than that of pacemaker area ((3.21±0.49) mV vs (4.19±0.73) mV),and the difference was statistically significant (t =-3.67,P＜0.05);however,there was no significant difference in wave velocity ((6.44±0.82) mm/s vs (7.24±1.37) mm/s,P＞0.05).Conclusions The normal human gastric pacemaker is located in mid and upper corpus near the greater curvature,which produces slow wave and control whole gastric electrical activity.The amplitude and velocity of slow waves are in gradient changes in different gastric regions.HRM is a mature and reliable research method to study the spatio-temporal characteristics of gastric electrical activity,which provides the possibility for the study of abnormal gastric electrical activity.
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Objective To investigate the spatio-temporal characteristics of normal gastric electrical activity.Methods From January 1st to February 29th,2016,fasting gastric electric slow wave signal was collected by high resolution mapping (HRM) under anesthesia before operation in patients without gastric lesions but needed laparoscopic surgery.Parameters of slow wave signal activity was calculated,gastric activity map and velocities was drawn and then spatio-temporal characteristics of gastric electrical activity of different part of the stomach were obtained.Independent sample t test was performed for comparison of two groups and one-way analysis of variance was used for multiple group comparisons.Results The normal gastric pacing zone located in the upper middle part of gastric body near greater curvature.Electrical activity of gastric body spread to gastric antrum along the long axis of the stomach.No slow signal was recorded in the gastric fundus and the gastric cardia.The frequencies of slow waves of different parts of gastric was same and the mean value was 2.61 ±0.11 cycle per minute.Compared with that of gastric body,the slow wave amplitude of gastric pacing zone was higher ((4.19±0.73) mV vs (1.67± 0.89) mV) and the speed was faster (7.24± 1.37) mm/s vs (4.94± 0.20) mm/s);the differences were statistically significant (t=18.89 and 4.95,both P＜0.01).The slow wave amplitude of gastric antrum was higher than that of gastric body ((3.21±0.49) mV vs (1.67±0.89) mV) and the speed was also faster ((6.44±0.82) mm/s vs (4.94±0.20) mm/s);the differences were statistically significant (t=4.85 and 4.95,both P＜0.05).The slow wave amplitude of gastric antrum was lower than that of pacemaker area ((3.21±0.49) mV vs (4.19±0.73) mV),and the difference was statistically significant (t =-3.67,P＜0.05);however,there was no significant difference in wave velocity ((6.44±0.82) mm/s vs (7.24±1.37) mm/s,P＞0.05).Conclusions The normal human gastric pacemaker is located in mid and upper corpus near the greater curvature,which produces slow wave and control whole gastric electrical activity.The amplitude and velocity of slow waves are in gradient changes in different gastric regions.HRM is a mature and reliable research method to study the spatio-temporal characteristics of gastric electrical activity,which provides the possibility for the study of abnormal gastric electrical activity.
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The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
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Adulto , Humanos , Tumor Carcinoide , Colonoscopia , Centro Germinativo , Tecido Linfoide , Linfoma de Zona Marginal Tipo Células B , Tonsila Palatina , Reto , GêmeosRESUMO
Objective To evaluate the efficacy and safety of single forcep endoscopic purse-string suture closing the wound of cardia and gastric fundus after endoscopic full-thickness resection (EFTR) for patients with submucosal tumor (SMT).Methods The clinical data of 32 patients with wound in the cardia and gastric fundus after EFTR for SMT undergoing single forcep endoscopic purse-string suture in Endoscopy Center of Renmin Hospital of Wuhan University from January 2015 to January 2016 were collected.Completion of operation, postoperative complication and follow-up results of these patients were retrospectively analyzed.Results All of the patients successfully received EFTR and purse-string suture.The maximal diameter of tumors was 1-4 cm.The suture time was 10-15 min, and postoperative hospital stay was 5-10 d.Low fever and upper abdominal pain were found in 13 and 20 cases respectively, and all cases were alleviated or restored after conservative treatment.All patients underwent gastroscopy during follow-up of 1 month, and titanium clip and nylon rope were found on the wound surface in 29 cases (90.6%).Three months after operation, 28 patients underwent gastroscopy, and titanium clip but no nylon rope was detected in 15 cases (46.9%).Conclusion Single forcep endoscopic purse-string suture can effectively treat the postoperative wound in the cardia and gastric fundus of patients with submucosal tumors after EFTR.
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Objective To study the value of endoscopic treatment for patients with gastric submucosal tumor ( G-SMT ) . Methods The data of 1663 patients with G-SMT undergoing endoscopic treatment was retrospective reviewed from January 2008 to December 2013. Patients′ demographics, treatment outcomes, and follow-up were evaluated. Results A total of 1671 lesions of G-SMT were included in the study. The mean maximum size of lesions was (1. 50±1. 02) cm. Twenty lesions were treated by endoscopic mucosal resection, 296 lesions by endoscopic submucosal dissection (ESD), 7 lesions by ESD+nylon endoloop, 1011 lesions by endoscopic submucosal excavation, 44 lesions by submucosal tunneling endoscopic resection, and 285 lesions by endoscopic full-thickness resection. Endoscopic treatment failed in 8 cases. Postoperative pathology diagnosis included 554 liomyoma, 485 gastrointestinal stromal tumors, 160 ectopic pancreas, and other such as lipoma, neuroendocrine tumor and fibroma. There were 16 cases of bleeding and 18 cases of perforation after treatment. Except for 4 cases of bleeding and 2 cases of perforation underwent additional surgical procedures, all patients were managed by conservative treatments. During a median follow-up time of 36 months of 1226 cases, the recurrence rate was 1％( 12/1226) ,and no death occurred. Conclusion Endoscopic treatment is safe and effective in treating G-SMT for long-term outcomes.
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BACKGROUND/AIMS: In recent years, endoscopic submucosal tunnel dissection (ESTD) has gained popularity worldwide. The aim of this study was to evaluate the safety and efficacy of ESTD in treating upper gastrointestinal submucosal tumors (SMTs) in a large-volume endoscopic center. METHODS: Patients with SMTs were enrolled in this study between January 2012 and January 2015. Demographic data, clinical data, and treatment outcome were collected and analyzed. RESULTS: Seventy SMTs originating from the muscularis propria (MP) layer were identified in 69 patients. All patients successfully underwent the ESTD procedure. The mean procedure time was 49.0±29.5 minutes, and the mean tumor size was 18.7±7.2 mm. Among all lesions, the majority (70.0%) were located in the esophagus, 12.9% in the cardia, and 17.1% in the stomach. Complete resection was achieved in 67 lesions (95.7%). Perforation occurred in three patients (4.3%), who were treated by endoclips. Pneumothorax occurred in two patients (2.9%) and was successfully managed by thoracic drainage. During a median follow-up of 18.1 months, patients were free of local recurrence or distant metastasis. CONCLUSIONS: Our results demonstrated the feasibility and safety of ESTD in treating upper gastrointestinal SMTs originating from the MP layer. Large-scale comparative studies with other treatment methods should be conducted in the future.
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Humanos , Cárdia , Drenagem , Esôfago , Seguimentos , Metástase Neoplásica , Pneumotórax , Recidiva , Estômago , Resultado do TratamentoRESUMO
Submucosal tumors (SMTs) originate from tissues that constitute the submucosal layer and muscularis propria, and are covered by normal mucosa. Esophageal SMTs are rare, accounting for <1% of all esophageal tumors. However, the recent widespread use of endoscopy has led to a rapid increase in incidental detection of SMTs in Korea. Esophageal SMTs are benign in ≥90% of cases, but the possibility of malignancies such as gastrointestinal stromal tumor and malignant leiomyosarcoma still exists. Therefore, patients undergo resection in the presence of symptoms or the possibility of a malignant tumor. For resection of esophageal SMTs, surgical resection was the only option available in case of possible malignancy, but minimally invasive surgery by endoscopic resection is becoming more preferable to surgical resection with the development of endoscopic ultrasonography, endoscopic techniques, and other devices.
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Humanos , Endoscopia , Endossonografia , Tumores do Estroma Gastrointestinal , Coreia (Geográfico) , Leiomiossarcoma , Procedimentos Cirúrgicos Minimamente Invasivos , MucosaRESUMO
PURPOSE: Extraosseous Ewing's sarcoma (EOE) of the rectum is extremely rare: only three cases have been reported in the literature and none of these reports described their imaging findings in detail. Herein, we describe the tumor imaging and pathological features in detail. MATERIALS AND METHODS: We report a case of rectal EOE in a 72-year-old female who received local excision and was provisionally diagnosed with a rectal submucosal spindle cell tumor. We used immunohistochemistry, histopathology, and fluorescence in situ hybridization to characterize the tumor and provide a definitive diagnosis of EOE. RESULTS: MRI revealed a well-demarcated submucosal tumor with heterogeneous enhancement and hemorrhagic foci in rectum. EOE was diagnosed by positive staining of tumor cells for CD99 and Fli-1 by immunohistochemistry and the presence of the EWSR1 gene translocation by fluorescence in situ hybridization. Although the patient underwent radiation treatment and surgery, the tumor recurred after 4 months as revealed by computed tomography and magnetic resonance imaging. CONCLUSION: Rectal EOE may present as a rectal submucosal tumor. The understanding of imaging and histological characteristics of this tumor are critical for accurate diagnosis and appropriate aggressive treatment.