Endoscopic muscularis excavation for subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer.

BACKGROUND: Because of complicating anatomic factors, endoscopic submucosal dissection is seldom performed in subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer. AIM: This study was designed to evaluate the feasibility of endoscopic muscularis excavation for treating subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer. METHODS: Between December 2008 and December 2011, 68 patients with subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer were treated with endoscopic muscularis excavation. Key steps of the procedure included the following: (1) injecting a mixture solution into the submucosal layer after making several dots around the tumor; (2) making a cross incision of the overlying mucosa, and excavating the tumor from the muscularis propria layer; (3) closing the artificial ulcer with clips after tumor removal. RESULTS: The mean tumor size was 16.2 mm (range 7-35 mm). Endoscopic muscularis excavation was successfully performed in 65 out of 68 cases (success rate 95.6 %). Pathological diagnosis of these tumors included leiomyoma (39 out of 68) and gastrointestinal stromal tumor (29 out of 68). Perforation occurred in seven patients (10.3 %). No massive bleeding or delayed bleeding occurred. The median follow-up period after the procedure was 23 months (range 6-42 months). No residual or recurrent tumor was detected and no stricture occurred in patients during the follow-up period. CONCLUSIONS: Endoscopic muscularis excavation is a safe, effective and feasible procedure for providing accurate histopathologic evaluation and curative treatment for subepithelial tumors of the esophagogastric junction originating from the muscularis propria layer.

[Endoscopic submucosal enucleation for gastric submucosal tumors originated from muscularis propria layer: clinical analysis of 116 case].

OBJECTIVE: To explore the efficacy and safety of endoscopic submucosal enucleation (ESE) for gastric submucosal tumors (SMTs) originated from muscularis propria. METHODS: A total of 116 patients with gastric SMT originated from muscularis propria underwent ESE in Department of Gastroenterology of the Taizhou Hospital between July 2006 and March 2011. The occurrence of intra-operative and post-operative complications and corresponding treatment were recorded. After the treatment of ESE, the patients were followed up endoscopically. RESULTS: The success rate of operation was 96.6%. The mean time of the procedure was (51.9±16.3) min. Complications included intra-operative bleeding (n=9, 7.8%), perforation (n=20, 17.2%), and post-operative bleeding (n=3, 2.6%). Among them, 5 cases (4.3%) required surgical intervention. None of patient had other complications such as peritoneal abscess or peritonitis. The mean hospitalization time after ESE was 6.1 days. The median follow-up period was 12 months (range, 3-48 months) and there was no residual tumor or recurrence. CONCLUSION: ESE is a safe and feasible treatment for patients with gastric SMT originated from muscularis propria.