A retrospective study on the safety, diagnostic yield, and therapeutic effects of endoscopic unroofing for small gastric subepithelial tumors
A retrospective study on the safety, diagnostic yield, and therapeutic effects of endoscopic unroofing for small gastric subepithelial tumors
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DOI：
10.1016/j.gie.2016.04.019
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发表时间：
2016-12-01
影响因子：
7.7
通讯作者：
Puespoek, Andreas
中科院分区：
文献类型：
--
作者：
Dolak, Werner;Beer, Andrea;Puespoek, Andreas
背景和目的：准确诊断胃上皮下小肿瘤（SET）是评估其恶性潜能的关键。据报道，内窥镜去顶术可获得足够的组织样本用于组织学评价。本研究的目的是评估安全性，诊断率，并随着时间的推移，这种技术的潜在治疗效果。方法：前瞻性收集的临床资料进行回顾性分析，确定谁在维也纳医科大学从2003年1月至2012年12月进行内镜下去顶术的患者。人口统计学数据，适应症为内镜下去顶，术中不良事件，住院时间，组织学结果，和后续processs.Results：共14例患者（7名男性，7名女性;中位年龄，70岁;范围，51-95岁）进行内镜下去顶的14个胃SETs的平均直径为26 +/- 13毫米在EUS。在14例病例中的9例中，内窥镜去顶术仅用于诊断目的;在其余病例中，由于胃SETs出血，因此出于治疗目的进行了去顶术。14例中13例在技术上成功去顶，发现8例胃肠道间质瘤（GIST），平滑肌瘤、纤维息肉、血管球瘤、胰腺剩余物和组织学上的非诊断性材料各1例。术中出血是唯一的不良事件（4例），可以通过内窥镜进行治疗。14例患者中有10例进行了随访EUS（中位数，8个月）。值得注意的是，大多数患者表现出完全消退后，他们的胃SETs unroofing（白色光和EUS），包括血管球瘤，平滑肌瘤，和6的8例GIST.Conclusions：内镜unroofing是安全的，有一个非常有利的诊断率在这项研究中。出乎意料的是，它导致大多数胃SET完全消退。虽然它不是一种肿瘤根治性治疗，内镜去顶术可以是一个有价值的选择，以治疗局部不良事件的患者不适合手术治疗。
Background and Aims: Accurate diagnosis of small gastric subepithelial tumors (SETs) is essential to assess their malignant potential. Endoscopic unroofing has been reported to yield sufficient tissue samples for histologic evaluation. This study aimed to evaluate the safety, diagnostic yield, and potential therapeutic effects of this technique over time.Methods: This retrospective analysis of prospectively collected clinical data identified patients who underwent endoscopic unroofing at the Medical University of Vienna from January 2003 to December 2012. Demographic data, indications for endoscopic unroofing, intraprocedural adverse events, hospital stay, histologic results, and follow-up procedures were reviewed.Results: A total of 14 patients (7 men; 7 women; median age, 70 years; range, 51-95 years) underwent endoscopic unroofing of 14 gastric SETs with a mean diameter of 26 +/- 13 mm at EUS. In 9 of 14 cases, endoscopic unroofing was done exclusively for diagnostic purposes; in the remaining cases, it was performed with therapeutic intent because of bleeding from the gastric SETs. Unroofing was technically successful in 13 of 14 cases and revealed 8 cases of GI stromal tumor (GIST) and 1 case each of leiomyoma, fibroid polyp, glomus tumor, pancreatic rest, and nondiagnostic material at histology. Intraprocedural bleeding was the only adverse event (4 cases) and could be managed endoscopically. A follow-up EUS was available (median, 8 months) for 10 of the 14 patients. Notably, most patients showed complete regression of their gastric SETs after unroofing (on white light and EUS), including the glomus tumor, the leiomyoma, and 6 of the 8 cases of GIST.Conclusions: Endoscopic unroofing was safe and had a very favorable diagnostic yield in this study. Unexpectedly, it led to complete regression in most gastric SETs. Although it is not an oncologically curative treatment, endoscopic unroofing can be a valuable option to treat local adverse events in patients unfit for surgical therapy.