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Erschienen in:

13.08.2020

Peroral endoscopic tumor resection (POET) with preserved mucosa technique for management of upper gastrointestinal tract subepithelial tumors

verfasst von: Chen-Shuan Chung, Kuo-Hsin Chen, Kuan-Chih Chen, Chiung-Yu Chen, Tzong-Hsi Lee, Cheng-Kuan Lin, Jiann-Ming Wu

Erschienen in: Surgical Endoscopy | Ausgabe 7/2021

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Abstract

Background

Third space endoscopy technique facilitates therapeutic endoscopy in subepithelial space. This study aimed to investigate peroral endoscopic tumor resection (POET) with preserved mucosa technique for upper gastrointestinal tract subepithelial tumors (UGI-SETs) removal.

Methods

Between February 2011 and December 2019, consecutive patients with SETs of esophagus and stomach who underwent POET for enlarging size during follow-up, malignant endoscopic ultrasound features or by patient’s request were enrolled. Demographic, endoscopic and pathological data were analyzed retrospectively.

Results

Totally 18 esophageal (mean ± SD age, 55.23 ± 4.15 year-old, 38.89% female) and 30 gastric (52.65 ± 2.43 year-old, 53.33% female) SETs in 47 patients (one with both esophageal and gastric lesions) were resected. The mean (± SD) endoscopic/pathological tumor size, procedure time, en-bloc/complete resection rate, and hospital stays of esophageal and gastric SET patients were 12.36 (± 7.89)/11.86 (± 5.67) and 12.57 (± 6.25)/12.35 (± 5.73) mm, 14.86 (± 6.15) and 38.21 (± 15.29) minutes, 88.89%/94.44% and 86.77%/93.30%, and 4.14 (± 0.21) and 4.17 (± 0.20) days, respectively. The overall complication rate was 18.75%, including 6 self-limited fever and 3 pneumoperitoneum relieved by needle puncture. There was no mortality or recurrence reported with mean follow-up period of 23.74 (± 4.12) months.

Conclusions

POET is a safe and efficient third space endoscopic resection technique for removal of UGI-SETs less than 20 mm. Long term data are warranted to validate these results.
Literatur
1.
Zurück zum Zitat Hedenbro JL, Ekelund M, Wetterberg P (1991) Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc. 5(1):20–23CrossRef Hedenbro JL, Ekelund M, Wetterberg P (1991) Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc. 5(1):20–23CrossRef
2.
Zurück zum Zitat Hwang JH, Rulyak SD, Kimmey MB, Institute AGA (2006) American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 130(7):2217–2228CrossRef Hwang JH, Rulyak SD, Kimmey MB, Institute AGA (2006) American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 130(7):2217–2228CrossRef
3.
Zurück zum Zitat Lim YJ, Son HJ, Lee JS, Byun YH, Suh HJ, Rhee PL, Kim JJ, Rhee JC (2010) Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy. World J Gastroenterol 16(4):439–444CrossRef Lim YJ, Son HJ, Lee JS, Byun YH, Suh HJ, Rhee PL, Kim JJ, Rhee JC (2010) Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy. World J Gastroenterol 16(4):439–444CrossRef
4.
Zurück zum Zitat Fang YJ, Cheng TY, Sun MS, Yang CS, Chen JH, Liao WC, Wang HP (2012) Suggested cutoff tumor size for management of small EUS-suspected gastric gastrointestinal stromal tumors. J Formos Med Assoc 111(2):88–93CrossRef Fang YJ, Cheng TY, Sun MS, Yang CS, Chen JH, Liao WC, Wang HP (2012) Suggested cutoff tumor size for management of small EUS-suspected gastric gastrointestinal stromal tumors. J Formos Med Assoc 111(2):88–93CrossRef
5.
Zurück zum Zitat Lin CL, Chen KC, Lin CK, Tsai CC, Lee TH, Chung CS (2019) Importance of tissue acquisition in gastric submucosal tumor with unusual EUS features. Gastrointest Endosc 89(6):1252–1254CrossRef Lin CL, Chen KC, Lin CK, Tsai CC, Lee TH, Chung CS (2019) Importance of tissue acquisition in gastric submucosal tumor with unusual EUS features. Gastrointest Endosc 89(6):1252–1254CrossRef
6.
Zurück zum Zitat Osoegawa T, Minoda Y, Ihara E, Komori K, Aso A, Goto A, Itaba S, Ogino H, Nakamura K, Harada N, Makihara K, Tsuruta S, Yamamoto H, Ogawa Y (2019) Mucosal incision-assisted biopsy versus endoscopic ultrasound-guided fine-needle aspiration with a rapid on-site evaluation for gastric subepithelial lesions: a randomized cross-over study. Dig Endosc 31(4):413–421CrossRef Osoegawa T, Minoda Y, Ihara E, Komori K, Aso A, Goto A, Itaba S, Ogino H, Nakamura K, Harada N, Makihara K, Tsuruta S, Yamamoto H, Ogawa Y (2019) Mucosal incision-assisted biopsy versus endoscopic ultrasound-guided fine-needle aspiration with a rapid on-site evaluation for gastric subepithelial lesions: a randomized cross-over study. Dig Endosc 31(4):413–421CrossRef
7.
Zurück zum Zitat Pih GY, Kim DH (2019) Endoscopic ultrasound-guided fine needle aspiration and biopsy in gastrointestinal subepithelial tumors. Clin Endosc 52(4):314–320CrossRef Pih GY, Kim DH (2019) Endoscopic ultrasound-guided fine needle aspiration and biopsy in gastrointestinal subepithelial tumors. Clin Endosc 52(4):314–320CrossRef
8.
Zurück zum Zitat Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. Natl Compr Cancer Netw 8(Suppl 2):S1–S41CrossRef Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. Natl Compr Cancer Netw 8(Suppl 2):S1–S41CrossRef
9.
Zurück zum Zitat Nishida T, Goto O, Raut CP, Yahagi N (2016) Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer 122(20):3110–3118CrossRef Nishida T, Goto O, Raut CP, Yahagi N (2016) Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer 122(20):3110–3118CrossRef
10.
Zurück zum Zitat Nishida T, Kawai N, Yamaguchi S, Nishida Y (2013) Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 25(5):479–489CrossRef Nishida T, Kawai N, Yamaguchi S, Nishida Y (2013) Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 25(5):479–489CrossRef
11.
Zurück zum Zitat Okumura S, Kanaya S, Hosogi H, Ito T, Miura S, Okada T, Shimoike N, Akagawa S, Kawada H, Arimoto A (2017) Our experience with laparoscopic partial gastrectomy by the 'lift-and-cut method' for gastric gastrointestinal stromal tumor with maximal preservation of the remnant stomach. Surg Endosc 31(8):3398–3404CrossRef Okumura S, Kanaya S, Hosogi H, Ito T, Miura S, Okada T, Shimoike N, Akagawa S, Kawada H, Arimoto A (2017) Our experience with laparoscopic partial gastrectomy by the 'lift-and-cut method' for gastric gastrointestinal stromal tumor with maximal preservation of the remnant stomach. Surg Endosc 31(8):3398–3404CrossRef
12.
Zurück zum Zitat An W, Sun PB, Gao J, Jiang F, Liu F, Chen J, Wang D, Li ZS, Shi XG (2017) Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surg Endosc 31(11):4522–4531CrossRef An W, Sun PB, Gao J, Jiang F, Liu F, Chen J, Wang D, Li ZS, Shi XG (2017) Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study. Surg Endosc 31(11):4522–4531CrossRef
13.
Zurück zum Zitat Catalano F, Rodella L, Lombardo F, Silano M, Tomezzoli A, Fuini A, Di Cosmo MA, de Manzoni G, Trecca A (2013) Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study. Gastric Cancer 16(4):563–570CrossRef Catalano F, Rodella L, Lombardo F, Silano M, Tomezzoli A, Fuini A, Di Cosmo MA, de Manzoni G, Trecca A (2013) Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study. Gastric Cancer 16(4):563–570CrossRef
14.
Zurück zum Zitat Li L, Wang F, Wu B, Wang Q, Wang C, Liu J (2013) Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria. Exp Ther Med 6(2):391–395CrossRef Li L, Wang F, Wu B, Wang Q, Wang C, Liu J (2013) Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria. Exp Ther Med 6(2):391–395CrossRef
15.
Zurück zum Zitat Chiu PWY, Yip HC, Teoh AYB, Wong VWY, Chan SM, Wong SKH, Ng EKW (2019) Per oral endoscopic tumor (POET) resection for treatment of upper gastrointestinal subepithelial tumors. Surg Endosc 33(4):1326–1333CrossRef Chiu PWY, Yip HC, Teoh AYB, Wong VWY, Chan SM, Wong SKH, Ng EKW (2019) Per oral endoscopic tumor (POET) resection for treatment of upper gastrointestinal subepithelial tumors. Surg Endosc 33(4):1326–1333CrossRef
16.
Zurück zum Zitat Dellatore P, Bhagat V, Kahaleh M (2019) Endoscopic full thickness resection versus submucosal tunneling endoscopic resection for removal of submucosal tumors: a review article. Transl Gastroenterol Hepatol 4:45CrossRef Dellatore P, Bhagat V, Kahaleh M (2019) Endoscopic full thickness resection versus submucosal tunneling endoscopic resection for removal of submucosal tumors: a review article. Transl Gastroenterol Hepatol 4:45CrossRef
17.
Zurück zum Zitat Maydeo A, Dhir V (2017) Third-space endoscopy: stretching the limits. Gastrointest Endosc 85(4):728–729CrossRef Maydeo A, Dhir V (2017) Third-space endoscopy: stretching the limits. Gastrointest Endosc 85(4):728–729CrossRef
18.
Zurück zum Zitat Tu S, Huang S, Li G, Tang X, Qing H, Gao Q, Fu J, Du G, Gong W (2018) Submucosal tunnel endoscopic resection for esophageal submucosal tumors: a multicenter study. Gastroenterol Res Pract 2018:2149564 Tu S, Huang S, Li G, Tang X, Qing H, Gao Q, Fu J, Du G, Gong W (2018) Submucosal tunnel endoscopic resection for esophageal submucosal tumors: a multicenter study. Gastroenterol Res Pract 2018:2149564
19.
Zurück zum Zitat Hu ML, Wu KL, Changchien CS, Chuah SK, Chiu YC (2017) Endosonographic surveillance of 1–3 cm gastric submucosal tumors originating from muscularis propria. World J Gastroenterol 23(12):2194–2200CrossRef Hu ML, Wu KL, Changchien CS, Chuah SK, Chiu YC (2017) Endosonographic surveillance of 1–3 cm gastric submucosal tumors originating from muscularis propria. World J Gastroenterol 23(12):2194–2200CrossRef
20.
Zurück zum Zitat Correa-Cote J, Morales-Uribe C, Sanabria A (2014) Laparoscopic management of gastric gastrointestinal stromal tumors. World J Gastrointest Endosc 6(7):296–303CrossRef Correa-Cote J, Morales-Uribe C, Sanabria A (2014) Laparoscopic management of gastric gastrointestinal stromal tumors. World J Gastrointest Endosc 6(7):296–303CrossRef
21.
Zurück zum Zitat Tatara T, Kanaji S, Suzuki S, Ishida R, Hasegawa H, Yamamoto M, Matsuda Y, Yamashita K, Oshikiri T, Matsuda T, Nakamura T, Sumi Y, Kakeji Y (2019) Evaluation of the result of single-incision laparoscopic surgery for gastrointestinal stromal tumors in the stomach. Surg Case Rep 5(1):50CrossRef Tatara T, Kanaji S, Suzuki S, Ishida R, Hasegawa H, Yamamoto M, Matsuda Y, Yamashita K, Oshikiri T, Matsuda T, Nakamura T, Sumi Y, Kakeji Y (2019) Evaluation of the result of single-incision laparoscopic surgery for gastrointestinal stromal tumors in the stomach. Surg Case Rep 5(1):50CrossRef
22.
Zurück zum Zitat von Rahden BH, Stein HJ, Feussner H, Siewert JR (2004) Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc 18(6):924–930CrossRef von Rahden BH, Stein HJ, Feussner H, Siewert JR (2004) Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc 18(6):924–930CrossRef
23.
Zurück zum Zitat Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W (2010) Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc 71(4):722–727CrossRef Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W (2010) Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc 71(4):722–727CrossRef
24.
Zurück zum Zitat Lim TW, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ (2016) Endoscopic ultrasound without tissue acquisition has poor accuracy for diagnosing gastric subepithelial tumors. Medicine (Baltimore) 95(44):e5246CrossRef Lim TW, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ (2016) Endoscopic ultrasound without tissue acquisition has poor accuracy for diagnosing gastric subepithelial tumors. Medicine (Baltimore) 95(44):e5246CrossRef
25.
Zurück zum Zitat Wu A, Li R, Shi D, Zhang D, Wang C, Yan S (2015) Diagnostic value of endoscopic ultrasonography for submucosal tumors of upper gastrointestinal tract. Zhonghua Wei Chang Wai Ke Za Zhi 18(11):1136–1138PubMed Wu A, Li R, Shi D, Zhang D, Wang C, Yan S (2015) Diagnostic value of endoscopic ultrasonography for submucosal tumors of upper gastrointestinal tract. Zhonghua Wei Chang Wai Ke Za Zhi 18(11):1136–1138PubMed
26.
Zurück zum Zitat Hunt GC, Smith PP, Faigel DO (2003) Yield of tissue sampling for submucosal lesions evaluated by EUS. Gastrointest Endosc 57(1):68–72CrossRef Hunt GC, Smith PP, Faigel DO (2003) Yield of tissue sampling for submucosal lesions evaluated by EUS. Gastrointest Endosc 57(1):68–72CrossRef
27.
Zurück zum Zitat Buscaglia JM, Nagula S, Jayaraman V, Robbins DH, Vadada D, Gross SA, DiMaio CJ, Pais S, Patel K, Sejpal DV, Kim MK (2012) Diagnostic yield and safety of jumbo biopsy forceps in patients with subepithelial lesions of the upper and lower GI tract. Gastrointest Endosc 75:1147–1152CrossRef Buscaglia JM, Nagula S, Jayaraman V, Robbins DH, Vadada D, Gross SA, DiMaio CJ, Pais S, Patel K, Sejpal DV, Kim MK (2012) Diagnostic yield and safety of jumbo biopsy forceps in patients with subepithelial lesions of the upper and lower GI tract. Gastrointest Endosc 75:1147–1152CrossRef
28.
Zurück zum Zitat Miettinen M, Sarlomo-Rikala M, Lasota J (1999) Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 30(10):1213–1220CrossRef Miettinen M, Sarlomo-Rikala M, Lasota J (1999) Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol 30(10):1213–1220CrossRef
29.
Zurück zum Zitat Hwang JH, Kimmey MB (2004) The incidental upper gastrointestinal subepithelial mass. Gastroenterology 126(1):301–307CrossRef Hwang JH, Kimmey MB (2004) The incidental upper gastrointestinal subepithelial mass. Gastroenterology 126(1):301–307CrossRef
30.
Zurück zum Zitat Committee AT, Aslanian HR, Sethi A, Bhutani MS, Goodman AJ, Krishnan K, Lichtenstein DR, Melson J, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, Maple JT (2019) ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 4(8):343–350CrossRef Committee AT, Aslanian HR, Sethi A, Bhutani MS, Goodman AJ, Krishnan K, Lichtenstein DR, Melson J, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, Maple JT (2019) ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection. VideoGIE 4(8):343–350CrossRef
31.
Zurück zum Zitat Wong VWY, Goto O, Gregersen H, Chiu PWY (2017) Endoscopic treatment of subepithelial lesions of the gastrointestinal tract. Curr Treat Options Gastroenterol 15(4):603–617CrossRef Wong VWY, Goto O, Gregersen H, Chiu PWY (2017) Endoscopic treatment of subepithelial lesions of the gastrointestinal tract. Curr Treat Options Gastroenterol 15(4):603–617CrossRef
32.
Zurück zum Zitat Chiu PW, Inoue H, Rösch T (2016) From POEM to POET: Applications and perspectives for submucosal tunnel endoscopy. Endoscopy 48(12):1134–1142CrossRef Chiu PW, Inoue H, Rösch T (2016) From POEM to POET: Applications and perspectives for submucosal tunnel endoscopy. Endoscopy 48(12):1134–1142CrossRef
33.
Zurück zum Zitat Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75(1):195–199CrossRef Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75(1):195–199CrossRef
34.
Zurück zum Zitat Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23(2):70–83CrossRef Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23(2):70–83CrossRef
Metadaten
Titel
Peroral endoscopic tumor resection (POET) with preserved mucosa technique for management of upper gastrointestinal tract subepithelial tumors
verfasst von
Chen-Shuan Chung
Kuo-Hsin Chen
Kuan-Chih Chen
Chiung-Yu Chen
Tzong-Hsi Lee
Cheng-Kuan Lin
Jiann-Ming Wu
Publikationsdatum
13.08.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 7/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07868-y

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