Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos)
Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos)
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DOI：
10.1007/s00464-014-3420-2
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发表时间：
2014-06-01
影响因子：
3.1
通讯作者：
Zhong, Yun-Shi
中科院分区：
文献类型：
--
作者：
Wang, Xiao-Yun;Xu, Mei-Dong;Zhong, Yun-Shi
食管胃交界处（EGJ）由于管腔狭窄、角度锐利，是内镜切除的困难部位。存在穿孔和纵隔感染的潜在风险增加，特别是对于源自固有肌层（MP）层的粘膜下肿瘤（SMT）。我们之前证明了粘膜下隧道内镜切除术（STER）治疗上消化道 SMT 的安全性和有效性，但 STER 用于切除 EGJ 处 SMT 的可行性需要系统研究。本次调查的目的是评估 STER 对 EGJ 处 SMT 去除的临床影响。进行了一项前瞻性研究，其中包括 2010 年 7 月至 2012 年 8 月期间在一个学术医疗中心对 57 名来自 MP 层的 EGJ 的 57 个 SMT 进行 STER 治疗的患者组成的连续队列。评估不良事件、整块切除率和局部复发。病灶的平均最大直径为21.5毫米（范围6-35毫米）。整块切除率为100%（57/57）。 STER 治疗后 57 名患者均未发生迟发性出血或严重不良事件。随访24个月无局部复发及远处转移。与吹入空气相比，CO2 发生的皮下气肿和纵隔气肿吸收时间 (p = 0.005) 较少。我们的研究表明，STER 安全有效，提供准确的组织病理学评估，并且对 EGJ 深层 MP 层的 SMT 具有疗效。建议注入 CO2 气体。
The esophagogastric junction (EGJ) is a difficult location for endoscopic resection due to its narrow lumen and sharp angle. Potential increased risks of perforation and mediastinal infection exist, especially for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. We previously demonstrated the safety and efficacy of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal SMTs, but the feasibility of STER for the removal of SMTs at the EGJ requires systematic investigation. The aim of the investigation was to evaluate the clinical impact of STER on the removal of SMTs at the EGJ.A prospective study was carried out which included a consecutive cohort of 57 patients who underwent STER for 57 SMTs of the EGJ originating from the MP layer between July 2010 and August 2012 in a single academic medical center. Adverse events, en bloc resection rate, and local recurrence were evaluated.The average maximum diameter of the lesions was 21.5 mm (range 6-35 mm). The en bloc resection rate was 100 % (57/57). No delayed hemorrhage or severe adverse events occurred in any of the 57 patients following STER. No local recurrence and distant metastasis occurred during 24 months' follow-up. Less subcutaneous emphysema and pneumomediastinum absorption time (p = 0.005) occurred with CO2 versus air insufflations.Our study showed that STER was safe and effective, provided accurate histopathologic evaluation, and was curative for SMTs of the deep MP layers at the EGJ. CO2 gas insufflation is recommended.