Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer.

BACKGROUND: This prospective study was designed to evaluate the safety and efficacy of submucosal tunneling endoscopic resection (STER) for small (≤3 cm) upper gastrointestinal (GI) subepithelial tumors (SETs) originating from the muscularis propria (MP) layer. METHODS: Between August 2011 and February 2013, a total of 85 patients with upper GI SETs originating from the MP layer were treated with STER. The key steps were as follows: (1) locating the tumor by injection of methylene blue or indigo carmine and then creating a submucosal tunnel from 5 cm above the tumor between the submucosal and muscular layers; (2) resecting the tumor by endoscopic resection techniques; (3) closing the mucosal incision site with several clips after the tumor is removed. RESULTS: Of the 85 SETs, 60 were located in the esophagus, 16 in the cardia, and 9 in the stomach. STER was successfully performed in all cases (success rate: 100 %). The mean tumor size was 19.2 mm. The mean procedure time was 57.2 min. The average hospital stay after the procedure was 5.9 days. Pathological diagnosis of the tumors were leiomyoma (65/85), gastrointestinal stromal tumor (GIST) (19/85), and calcifying fibrous tumor (1/85). During the procedure, eight patients developed pneumothorax, subcutaneous emphysema, and/or pneumoperitoneum. These patients recovered after conservative treatment. The rate of all complications was significantly higher for lesions originating in the deeper MP layer (70 %) than in the superficial MP layer (1.3 %; p < 0.001). The total complication rate for different histological diagnoses was also significantly different (26.3 % for GISTs, 4.6 % for leiomyomas, 0 % for calcifying fibrous tumors, p < 0.05). No residual or recurrent tumors were detected during the follow-up period (median: 8 months). CONCLUSIONS: Submucosal tunneling endoscopic resection appears to be a feasible, safe, and effective procedure for treatment of small (≤3 cm) upper GI SETs originating from the MP layer.

Submucosal tunnelling endoscopic resection for the treatment of esophageal submucosal tumours originating from the muscularis propria layer: an analysis of 15 cases.

BACKGROUND AND AIMS: The aim of this prospective study was to evaluate the feasibility of submucosal tunnelling endoscopic resection of esophageal tumours originating from the muscularis propria layer. METHODS: Fifteen patients with esophageal submucosal tumours originating from the muscularis propria layer underwent submucosal tunnelling endoscopic resection between August 2011 and February 2012. The key steps were: (1) creating a submucosal tunnel from 5 cm above the tumour between the submucosal and muscular layers with a hook knife or hybrid knife; (2) dissecting the tumour by the technique of endoscopic submucosal dissection; (3) closing the mucosal incision site with clips after the tumour was removed. RESULTS: Submucosal tunnelling endoscopic resection was successfully performed in all cases. The en bloc resection rate was 100%. The average tumour diameter was 1.8 cm (range 1.0-3.0 cm). During the procedure, perforation occurred in 3 patients, who recovered after conservative treatment. No residual tumour or tumour recurrence was detected during the follow-up period (mean: 3.5 months, range: 1-9 months). Pathological diagnoses of these tumours were leiomyomas (12/15) and gastrointestinal stromal tumours (3/15). CONCLUSIONS: Submucosal tunnelling endoscopic resection is a feasible method for the treatment of small esophageal submucosal tumours originating from the muscularis propria layer.

Intramuscular injection of metoclopramide decreases the gastric transit time and does not increase the complete examination rate of capsule endoscopy: a prospective randomized controlled trial.

BACKGROUND/AIMS: Capsule endoscopy (CE) reaches the cecum in about 80% of cases. Decreasing the gastric transit time (GTT) may increase the complete examination rate (CER). METHODOLOGY: Patients (n=177) were prospectively randomized into 2 groups: the control group (n=88) and the intramuscular injection with metoclopramide (IIM) group (n=89). The OMOM CE system, which has the function of real-time monitoring, was used. The patients were injected with metoclopramide 15 minutes before swallowing the CE in the IIM group. The CE would be sent into the duodenum by gastroscopy if the GTT reached 120 minutes in the two groups. RESULTS: No significant difference was noted between the two groups. Of the 169 cases without gastroscopic help, the mean GTT was shorter in the IIM group (n=87) than the control group (n=82) (p=0.002). But the CER was similar. Of 135 cases without gastroscopic help but reached the cecum, the mean GTT was shorter in the IIM group (n=71) than the control group (n=64) (p=0.015). But the mean small bowel transit time (SBTT) was similar. CONCLUSIONS: Intramuscular injection of metoclopramide decreases the gastric transit time, but it does not change the SBTT or CER of capsule endoscopy in our study.