Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video)

Białek, Andrzej; Wiechowska-Kozłowska, Anna; Pertkiewicz, Jan; Polkowski, Marcin; Milkiewicz, Piotr; Karpińska, Katarzyna; Ławniczak, Małgorzata; Starzyńska, Teresa

doi:10.1016/j.gie.2011.08.029

« Previous Next »Gastrointestinal Endoscopy
Volume 75, Issue 2 , Pages 276-286, February 2012

Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video)

Andrzej Białek, MD
- Gastroenterology Department, Pomeranian Medical University, Szczecin, Poland
- Reprint requests: Andrzej Bialek, MD, Gastroenterology Department, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-242 Szczecin, Poland
Anna Wiechowska-Kozłowska, MD
- Department of Endoscopy, Ministry of Internal Affairs Hospital, Szczecin, Poland
Jan Pertkiewicz, MD
- Endotherapy Ltd, Warsaw, Poland
Marcin Polkowski, MD, PhD
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland
- Department of Gastroenterology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
Piotr Milkiewicz, MD, PhD
- Department of Endoscopy, Ministry of Internal Affairs Hospital, Szczecin, Poland
- Liver Unit, Pomeranian Medical University, Szczecin, Poland
Katarzyna Karpińska, MD
- Cell Pathology Department, Pomeranian Medical University, Szczecin, Poland
Małgorzata Ławniczak, MD
- Gastroenterology Department, Pomeranian Medical University, Szczecin, Poland
Teresa Starzyńska, MD, PhD
- Gastroenterology Department, Pomeranian Medical University, Szczecin, Poland

Received 12 April 2011; accepted 15 August 2011. published online 28 October 2011.

Background

Endoscopic submucosal dissection (ESD) is a well-accepted method for removing superficial mucosal tumors; however, there is limited data on the use of this method for removing subepithelial tumors.

Objective

To investigate the efficacy, safety, and outcome of ESD for gastric subepithelial tumors and determine factors related to treatment success.

Design

Retrospective analysis of a prospectively maintained database.

Setting

Single tertiary academic center.

Patients and Interventions

From April 2007 to November 2010, 37 patients with gastric subepithelial tumors were treated with ESD.

Main Outcome Measurements

Macroscopically and microscopically complete en block resection rate (R0), complication rate, and endosonographic features predictive of R0 resection.

Results

The median tumor diameter was 25.0 mm, (range 10-60 mm, IQR 17-37). The overall rate of R0 resections was 81.1% (30/37, 95%CI: 61.8-90.2%), including 100% (15/15, 95%CI: 78.2-100.0%) of tumors from the submucosa and 68.2% (15/22, 95%CI: 45.1-86.1%) of tumors from the muscularis propria. Seventeen patients had a final diagnosis of gastrointestinal stromal tumor. The severe complication (perforation) rate was 5.4% (2/37, 95%CI: 0.0-9.5%). One patient required surgery; the other was treated conservatively. No recurrence was observed in patients with R0 resections at a median follow up of 21.0 months (IQR 11-35). Successful R0 resections were predicted by the observation of no, or only narrow, tumor connections with the underlying muscle layer during EUS (OR=35.0, 95%CI: 3.7-334.4, p=0.001).

Limitations

Single-center, retrospective analysis, short follow-up.

Conclusions

ESD is an effective and relatively safe method for removing gastric subepithelial tumors. Endoscopic ultrasonography findings can predict complete tumor resections.

Abbreviations: CI, confidence interval, ESD, endoscopic submucosal dissection, EUS-FNA, EUS-guided FNA, IQR, interquartile range, SET, subepithelial tumor