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Endoscopic Treatment of Subepithelial Tumors

  • Kim, Su Young (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kim, Kyoung-Oh (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center)
  • Received : 2018.01.02
  • Accepted : 2018.01.15
  • Published : 2018.01.30

Abstract

Gastrointestinal subepithelial tumors (SETs) are generally found during endoscopy and their incidence has gradually increased. Although the indications for the endoscopic treatment of patients with SETs remain to be established, the feasibility and safety of endoscopic dissection, including the advantages of this method compared with surgical treatment, have been validated in many studies. The development of endoscopic techniques, such as endoscopic submucosal dissection, endoscopic enucleation, endoscopic excavation, endoscopic submucosal tunnel dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection has enabled the removal of SETs while reducing the occurrence of complications. Here, we discuss the endoscopic treatment of patients with SETs, outcomes for endoscopic treatment, and procedure-related complications. We also consider the advantages and disadvantages of the various endoscopic techniques.

Keywords

References

  1. Ponsaing LG, Hansen MB. Therapeutic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007;13:3316-3322. https://doi.org/10.3748/wjg.v13.i24.3316
  2. Chun SY, Kim KO, Park DS, et al. Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: a preliminary analysis of appropriate indications. Surg Endosc 2013;27:3271-3279. https://doi.org/10.1007/s00464-013-2904-9
  3. He Z, Sun C, Wang J, et al. Efficacy and safety of endoscopic submucosal dissection in treating gastric subepithelial tumors originating in the muscularis propria layer: a single-center study of 144 cases. Scand J Gastroenterol 2013;48:1466-1473. https://doi.org/10.3109/00365521.2013.845796
  4. Bialek A, Wiechowska-Kozlowska A, Pertkiewicz J, et al. Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc 2012;75:276-286. https://doi.org/10.1016/j.gie.2011.08.029
  5. Schmidt A, Bauder M, Riecken B, von Renteln D, Muehleisen H, Caca K. Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series. Endoscopy 2015;47:154-158.
  6. Kim SY, Kim KO. Management of gastric subepithelial tumors: the role of endoscopy. World J Gastrointest Endosc 2016;8:418-424. https://doi.org/10.4253/wjge.v8.i11.418
  7. Wong VWY, Goto O, Gregersen H, Chiu PWY. Endoscopic treatment of subepithelial lesions of the gastrointestinal tract. Curr Treat Options Gastroenterol 2017;15:603-617. https://doi.org/10.1007/s11938-017-0152-0
  8. Zhang Y, Ye LP, Mao XL. Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer. World J Gastroenterol 2015;21:9503-9511. https://doi.org/10.3748/wjg.v21.i32.9503
  9. Yu JP, Luo HS, Wang XZ. Endoscopic treatment of submucosal lesions of the gastrointestinal tract. Endoscopy 1992;24:190-193. https://doi.org/10.1055/s-2007-1010460
  10. Kojima T, Takahashi H, Parra-Blanco A, Kohsen K, Fujita R. Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection. Gastrointest Endosc 1999;50:516-522. https://doi.org/10.1016/S0016-5107(99)70075-1
  11. Kim GH. Endoscopic resection of subepithelial tumors. Clin Endosc 2012;45:240-244. https://doi.org/10.5946/ce.2012.45.3.240
  12. Lee DG, Kim GH, Park DY, et al. Endoscopic submucosal resection of esophageal subepithelial lesions using band ligation. Endoscopy 2011;43:822-825. https://doi.org/10.1055/s-0030-1256615
  13. Kajiyama T, Sakai M, Torii A, et al. Endoscopic aspiration lumpectomy of esophageal leiomyomas derived from the muscularis mucosae. Am J Gastroenterol 1995;90:417-422.
  14. Chung IK, Lee JH, Lee S-H, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD study group multicenter study. Gastrointest Endosc 2009;69:1228-1235. https://doi.org/10.1016/j.gie.2008.09.027
  15. Lee IL, Lin PY, Tung SY, Shen CH, Wei KL, Wu CS. Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy 2006;38:1024-1028. https://doi.org/10.1055/s-2006-944814
  16. Liu BR, Song JT, Qu B, Wen JF, Yin JB, Liu W. Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria. Surg Endosc 2012;26:3141-3148. https://doi.org/10.1007/s00464-012-2305-5
  17. Ye LP, Zhu LH, Zhou XB, Mao XL, Zhang Y. Endoscopic excavation for the treatment of small esophageal subepithelial tumors originating from the muscularis propria. Hepatogastroenterology 2015;62:65-68.
  18. Jeong ID, Jung SW, Bang SJ, Shin JW, Park NH, Kim DH. Endoscopic enucleation for gastric subepithelial tumors originating in the muscularis propria layer. Surg Endosc 2011;25:468-474. https://doi.org/10.1007/s00464-010-1195-7
  19. Chu YY, Lien JM, Tsai MH, et al. Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer. BMC Gastroenterol 2012;12:124. https://doi.org/10.1186/1471-230X-12-124
  20. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010;42:265-271. https://doi.org/10.1055/s-0029-1244080
  21. Hoteya S, Iizuka T, Kikuchi D, Yahagi N. Endoscopic submucosal dissection for gastric submucosal tumor, endoscopic sub-tumoral dissection. Dig Endosc 2009;21:266-269. https://doi.org/10.1111/j.1443-1661.2009.00905.x
  22. Li L, Wang F, Wu B, Wang Q, Wang C, Liu J. Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria. Exp Ther Med 2013;6:391-395. https://doi.org/10.3892/etm.2013.1181
  23. Zhang Y, Ye LP, Zhou XB, et al. Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer: results from a large study in China. J Clin Gastroenterol 2013;47:689-694. https://doi.org/10.1097/MCG.0b013e3182908295
  24. Catalano F, Rodella L, Lombardo F, et al. Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study. Gastric Cancer 2013;16:563-570. https://doi.org/10.1007/s10120-012-0225-7
  25. Inoue H, Ikeda H, Hosoya T, et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012;44:225-230. https://doi.org/10.1055/s-0031-1291659
  26. Gong W, Xiong Y, Zhi F, Liu S, Wang A, Jiang B. Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors. Endoscopy 2012;44:231-235. https://doi.org/10.1055/s-0031-1291720
  27. Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou X, Chen JY. Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc 2014;28:524-530. https://doi.org/10.1007/s00464-013-3197-8
  28. Zhou DJ, Dai ZB, Wells MM, Yu DL, Zhang J, Zhang L. Submucosal tunneling and endoscopic resection of submucosal tumors at the esophagogastric junction. World J Gastroenterol 2015;21:578-583. https://doi.org/10.3748/wjg.v21.i2.578
  29. Li QL, Chen WF, Zhang C, et al. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc 2015;29:3640-3646. https://doi.org/10.1007/s00464-015-4120-2
  30. Chen T, Zhou PH, Chu Y, et al. Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg 2017;265:363-369. https://doi.org/10.1097/SLA.0000000000001650
  31. Zhou PH, Yao LQ, Qin XY, et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 2011;25:2926-2931. https://doi.org/10.1007/s00464-011-1644-y
  32. Ye LP, Yu Z, Mao XL, Zhu LH, Zhou XB. Endoscopic full-thickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc 2014;28:1978-1983. https://doi.org/10.1007/s00464-014-3421-1
  33. Xu MD, Cai MY, Zhou PH, et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 2012;75:195-199. https://doi.org/10.1016/j.gie.2011.08.018
  34. Liu BR, Song JT, Kong LJ, Pei FH, Wang XH, Du YJ. Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia. Surg Endosc 2013;27:4354-4359. https://doi.org/10.1007/s00464-013-3023-3
  35. Wang XY, Xu MD, Yao LQ, et al. Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos). Surg Endosc 2014;28:1971-1977. https://doi.org/10.1007/s00464-014-3420-2
  36. Lu J, Zheng M, Jiao T, Wang Y, Lu X. Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy 2014;46:888-892. https://doi.org/10.1055/s-0034-1377442
  37. Wang H, Tan Y, Zhou Y, et al. Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol 2015;27:776-780. https://doi.org/10.1097/MEG.0000000000000394
  38. Guo J, Liu Z, Sun S, et al. Endoscopic full-thickness resection with defect closure using an over-the-scope clip for gastric subepithelial tumors originating from the muscularis propria. Surg Endosc 2015;29:3356-3362. https://doi.org/10.1007/s00464-015-4076-2