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KMID : 0359020080360040193
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Korean Journal of Gastrointestinal Endoscopy
2008 Volume.36 No. 4 p.193 ~ p.199
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The Usefulness of Endoscopic Subtumoral Dissection for En-bloc Resection of Upper Gastrointestinal Submucosal Tumors
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Yoon Hyo-Joong
Ryu Chang-Beom
Na Hyun-Sik
Maeng Joo-Hee
Han Sang-Hoon
Ko Bong-Min
Hong Su-Jin
Cho Joo-Young
Lee Joon-Seong
Lee Moon-Sung
Shim Chan-Sup
Kim Boo-Sung
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Abstract
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Background/Aims: The removal of esophageal and gastric submucosal tumors is difficult using conventional
endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors.
Methods: An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal
tumors (M：F=10：5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed
in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal
dissection.
Results: Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5×21.1 mm. The mean procedure time was 49.4 minutes (range: 8∼103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery.
Conclusions: An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin. (Korean J Gastrointest Endosc 2008;36:193-199)
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KEYWORD
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Submucosal tumor, Endoscopic subtumoral
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