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Open Access Research article

Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer

Yin-Yi Chu12, Jau-Min Lien2, Ming-Hung Tsai2, Cheng-Tang Chiu2, Tse-Ching Chen4, Kuo-Ching Yang1 and Soh-Ching Ng3*

Author Affiliations

1 Department of Gastroenterology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

2 Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. College of Medicine, Chang Gung University, Taoyuan, Taiwan

3 Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. College of Medicine, Chang Gung University, Taoyuan, Taiwan

4 Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. College of Medicine, Chang Gung University, Taoyuan, Taiwan

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BMC Gastroenterology 2012, 12:124  doi:10.1186/1471-230X-12-124

Published: 14 September 2012

Abstract

Background

Gastric subepithelial tumors are usually asymptomatic and observed incidentally during endoscopic examination. Although most of these tumors are considered benign, some have a potential for malignant transformation, particularly those originating from the muscularis propria layer. For this type of tumor, surgical resection is the standard treatment of choice. With recent advent of endoscopic resection techniques and devices, endoscopic submucosal dissection (ESD) has been considered as an alternative way of treatment. The aim of this study is to demonstrate the feasibility of a modified ESD technique with enucleation for removal of gastric subepithelial tumors originating from the muscularis propria layer, and to evaluate its efficacy and safety.

Methods

From November 2009 to May 2011, a total of 16 patients received a modified ESD with enucleation for their subepithelial tumors. All tumors were smaller than 5 cm and originated from the muscularis propria layer of the stomach, as shown by endoscopic ultrasonography (EUS). The procedure was conducted with an insulated-tip knife 2. Patient’s demographics, tumor size and pathological diagnosis, procedure time, procedure-related complication, and treatment outcome were reviewed.

Results

Fifteen of the sixteen tumors were successful complete resection. The mean tumor size measured by EUS was 26.1 mm (range: 20–42 mm). The mean procedure time was 52 minutes (range: 30–120 minutes). Endoscopic features of the 4 tumors were pedunculated and 12 were sessile. Their immunohistochemical diagnosis was c-kit (+) stromal tumor in 14 patients and leiomyoma in 2 patients. There was no procedure-related perforation or overt bleeding. During a mean follow up duration of 14.8 months (range: 6–22 months), there was no tumor recurrence or metastasis.

Conclusions

Using a modified ESD with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer and larger than 2 cm, complete resection can be successfully performed without serious complication. It is a safe and effective alternative to surgical therapy for these tumors of 2 to 5 cm in size.

Keywords:
Endoscopic submucosal dissection; Gastrointestinal stromal tumors; Endoscopic ultrasonography