अमूर्त

Clinical analysis of submucosal tunneling endoscopic resection in treating esophageal submucosal tumors

Fu Xinjuan, Shi Xiuju, Liu Hualin, Liu Hui, Li Bin, Xu Hongwei

Background: Inspired by peroral Endoscopic Myotome (POEM), a new technique named Submucosal Tunneling Endoscopic Resection (STER) was developed for the treatment of submucosal gastrointestinal tumors.

Objective: To evaluate the clinical security and the feasibility of Submucosal Tunneling Endoscopic Resection (STER) for treating the submucosal tumors of esophageal.

Methods: Collecting cases during 2011 November to 2014 December in Shandong Provincial Hospital, all patients were diagnosed as esophageal submucosal tumors by Ultrasonography Endoscopic (EUS), and Computed Tomography (CT) scan. 58 patients were treated with STER, and 30 patients were treated with ESE, to observe two group’s indicators such as operation time, intraoperative and postoperative complications, tumor size, pathology and postoperative hospitalization days.

Results: All 58 patients’ tumors were resected en bloc successfully by STER at one time, the en bloc resection rate was 100%, the mean operation time was 63.24 ± 15.10 min, a bit shorter than the ESE group (71.97 ± 25.46 min), and there was significant difference between two groups (t=2.018, P=0.047). The mean size of the tumors was 2.07 ± 0.8 cm, larger than ESE group (1.28 ± 0.63 cm), and there was significant difference between two groups (t=4.659, P=0.013). No intraoperative perforation occurred in STER, and fevers 9 cases (15.8%), subcutaneous emphysema 3 cases (5.3%) and pneumothorax 2 cases (3.5%) were observed post operation, all patients recovered after conservative treatment. No delayed bleeding and secondary infection and esophageal fistula. The mean postoperative hospitalization days were 5.72 ± 2.24 d, no significant difference was observed compared with ESE group (6.27 ± 3.10 d). The incidence rate of fever, subcutaneous emphysema and pneumothorax of STER group were lower than the ESE group, but no statistical significance was observed. Three months later, gastroscope or Ultrasonography (EUS) review showed wound healing, and no residual tumor or relapse.

Conclusion: STER is a safe and feasible method for treating esophageal sumucosal tumors, and it worth of clinical promotion.