Submucosal tunnel endoscopic resection for extraluminal tumors: a novel endoscopic method for en bloc resection of predominant extraluminal growing subepithelial tumors or extra-gastrointestinal tumors (with videos)
Submucosal tunnel endoscopic resection for extraluminal tumors: a novel endoscopic method for en bloc resection of predominant extraluminal growing subepithelial tumors or extra-gastrointestinal tumors (with videos)
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粘膜下隧道内镜切除管腔外肿瘤：一种新颖的内镜方法，用于整块切除主要管腔外生长的上皮下肿瘤或胃肠外肿瘤（附视频）
DOI：
10.1016/j.gie.2018.02.032
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发表时间：
2018-07-01
影响因子：
7.7
通讯作者：
Zhou, Ping-Hong
中科院分区：
文献类型：
--
作者：
Cai, Ming-Yan;Zhu, Bo-Qun;Zhou, Ping-Hong
背景和目标：具有主要腔外生长模式的上皮下肿瘤或胃肠道外肿瘤的管理可能具有挑战性，传统上需要手术切除，这不仅是侵入性的，而且可能带来显著的发病率和死亡率风险。我们的目的是评估一种新的内镜技术的可行性，安全性和有效性，称为粘膜下隧道内镜切除术腔外肿瘤（STER-ET）。我们前瞻性地招募了接受过STER-ET治疗的胃肠道上皮下肿瘤的患者，这些肿瘤以腔外生长模式为主，或位于贲门水平或胃小弯近端的胃肠道外肿瘤。2016年1月至2017年3月，对8例患者进行了断层扫描。最长和最短尺寸的平均（+/-标准差）肿瘤尺寸分别为2.8 +/- 0.6 cm和2.3 +/- 0.8 cm。平均手术时间为67 +/- 4.4分钟。根治性整块切除率为100%，整块取出率为87.5%。在最终组织学检查中，6例肿瘤为胃肠道间质瘤，1例为神经鞘瘤，1例为前肠囊肿。5名患者在手术过程中出现二氧化碳腹膜炎，需要腹部减压。1例患者采用止血夹成功进行了小型粘膜切开术。无重大不良事件或死亡。平均住院时间为3天。平均随访期为10.0 +/- 2.1 months.Conclusions：在选定的一组患者中，STER-ET是一种新的技术，似乎是安全和有效的，在实现根治性切除胃肠道上皮下肿瘤的主要腔外生长模式或腔外肿瘤的监视成像上没有残留的肿瘤。然而，需要更大规模的研究来验证我们的发现。
Background and Aims: The management of subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors can be challenging and traditionally requires a surgical resection that is not only invasive but may carry a significant risk of morbidity and mortality. We aimed to assess the feasibility, safety, and efficacy of a novel endoscopic technique termed submucosal tunnel endoscopic resection for extraluminal tumors (STER-ET).Methods: We prospectively enrolled patients who underwent STER-ET for GI subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors located at the level of cardia or the proximal part of the lesser curvature of the stomach seen on cross-sectional imaging between January 2016 and March 2017.Results: Eight patients underwent STER-ET. The mean (+/- standard deviation) tumor size was 2.8 +/- 0.6 cm and 2.3 +/- 0.8 cm in longest and shortest dimension, respectively. The average procedure time was 67 +/- 4.4 minutes. The rates of curative en bloc resection and en bloc retrieval was 100% and 87.5%, respectively. On final histology, 6 tumors were GI stromal tumors, 1 was a schwannoma, and 1 was a foregut cyst. Five patients had capnoperitoneum during the procedure and required abdominal decompression. One patient had a small mucosotomy successfully treated with a hemostatic clip. There were no major adverse events or deaths. The median length of hospital stay was 3 days. There was no residual tumor on surveillance imaging after a mean follow-up period of 10.0 +/- 2.1 months.Conclusions: STER-ET is a novel technique that appears to be safe and effective in achieving a curative resection for GI subepithelial tumors with a predominantly extraluminal growth pattern or extraluminal tumors in a selected group of patients. However, larger studies are required to validate our finding.