• J. Am. Coll. Surg. · Jun 2022

    Submucosal Tunneling Endoscopic Resection for Submucosal Tumors in the Proximal Esophagus.

    • Tao Chen, Guo-Xiang Wang, Jing-Jing Lian, Ai-Ping Xu, Zhu-Yun Leng, Li Zhang, Sheng-Xi Li, Xiao-Yun Wang, and Mei-Dong Xu.
    • From the Endoscopy Center, Department of Gastroenterology (Chen, Lian, A-P Xu, Leng, M-D Xu), Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
    • J. Am. Coll. Surg. 2022 Jun 1; 234 (6): 1127-1135.

    BackgroundSubmucosal tunneling endoscopic resection (STER) is widely applied for treatment of gastrointestinal submucosal tumors (SMTs) originating from the muscularis propria layer. However, the tumor location within the proximal esophagus makes STER a challenge for the endoscopists. The aim of this study was to summarize the technique skill and evaluate the outcomes of proximal esophageal STER.Study DesignA total of 72 patients with SMTs in the proximal esophagus undergoing STER were included from February 2019 to March 2021. Imaging 3-dimensional reconstruction was used for patients with large SMTs. Clinicopathological, endoscopic, and follow-up data were collected and analyzed.ResultsIn this study, all the tumors were removed completely and no gross disease was remaining. The en bloc resection was achieved in 90.28% of patients, and the complications rate was 6.95%. Three-dimensional reconstruction was used for 30 patients (41.67%) with large SMTs (transverse diameter >2.0 cm). Based on statistical analysis, tumors with irregular shape and larger size were the significant contributors to piecemeal resection. Larger tumors increase the risk of long operation time, and irregular tumor shapes increase the risk of complications. The median hospitalization time was 4 days. All of the complications were cured by conservative treatment. A median follow-up of 12 months was available, and all patients were free from local recurrence or distant metastasis during the study period.ConclusionsSTER is an effective and safe methodology for the resection of proximal esophageal SMTs. Tumor size and shape mainly impact the piecemeal resection rate, STER-related complications, and procedural difficulty.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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