Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (3): 74-80.doi: 10.6040/j.issn.1671-7554.0.2020.1446

Previous Articles    

Evaluation of the efficacy and complications of endoscopic treatment of 240 cases of upper gastrointestinal submucosal tumors

LUO Yingshu1, LI Bin2, XU Changqin2, JIANG Junmei2, XU Hongwei1,2   

  1. 1. Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong, China;
    2. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2021-04-06

Abstract: Objective To explore the clinical characteristics of upper gastrointestinal submucosal tumors(SMT)and clinical factors affecting postoperative complications and hospitalization costs of SMT patients. Methods The clinical data of 240 SMT patients treated in Shandong Provincial Hospital during Jan. 2012 and Jun. 2019 were collected, and the clinical characteristics, pathological types, treatment modalities and therapeutic effects were analyzed. Results The patients included 101 male(42.1%)and 139 female(57.9%), mean age 54.19 years, and mean size of SMT 1.12 cm. The tumors were located in the esophagus in 57 cases(23.8%), in the gastroesophageal junction in 17 cases(7.1%), in the stomach in 163 cases(67.9%), and in the duodenum in 3 cases(1.3%). Endoscopic submucosal dissection(ESD)was performed in 69 patients(28.8%), endoscopic submucosal excavation(ESE)in 117 patients(48.8%), endoscopic full-thickness resection(EFR)in 28 patients(11.7%), and submucosal tunneling endoscopic resection(STER)in 26 patients(10.7%). The main pathological types were leiomyoma(117, 49.2%)and stromal tumor(78, 32.8%). Altogether 237 patients(98.8%)were successfully treated, with 90.4%(217/240)en bloc resection rate. The mean operation time was 58.37 minutes, hospital stay 10.07 days, and hospitalization costs 35 830.3 yuan. Complications were observed in 17 patients(7.1%), 10(4.2%)of whom relieved after conservative treatment and 7(2.9%)received active interventions such as endoscopic hemostasis, gastrointestinal decompression and puncture drainage. No death or long-term complications occurred. Operation time ≥55 min and SMT≥2 cm were the risk factors of postoperative complications; meanwhile, operation time ≥55 min, SMT≥2 cm, failure of en bloc resection and use of OTSC increased hospitalization costs. Conclusion Endoscopic resection is a safe and effective treatment modality of SMT. Early detection, early treatment and short operation time are effective ways to reduce the incidence of postoperative complications and hospitalization costs.

Key words: Submucosal tumors, Endoscope, Clinical characteristics, Efficacy, Complications

CLC Number: 

  • R735
[1] Nishida T, Kawai N, Yamaguchi S, et al. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors [J]. Dig Endosc, 2013, 25(5): 479-489.
[2] Papanikolaou IS, Triantafyllou K, Kourikou A, et al. Endoscopic ultrasonography for gastric submucosal lesions [J]. World J Gastrointest Endosc, 2011, 3(5): 86-94.
[3] Longcroft-Wheaton G, Bhandari P. Endoscopic resection of submucosal tumors [J]. Expert Rev Gastroenterol Hepatol, 2015, 9(5): 659-669.
[4] Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors [J]. Endoscopy, 2005, 37(7): 635-645.
[5] Nishida T, Goto O, Raut C P, et al. Diagnostic and treatment strategy for small gastrointestinal stromal tumors [J]. Cancer, 2016, 122(20): 3110-3118.
[6] Abe N, Takeuchi H, Ohki A, et al. Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor [J]. Dig Endosc, 2018, Suppl 1:7-16. doi: 10.1111/den.13010.
[7] Chai N, Du C, Gao Y, et al. Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic enucleation for esophageal submucosal tumors originating from the muscularis propria layer: a randomized controlled trial [J]. Surg Endosc, 2018, 32(7): 3364-3372.
[8] Kikuchi S, Nishizaki M, Kuroda S, et al. Nonexposure laparoscopic and endoscopic cooperative surgery(closed laparoscopic and endoscopic cooperative surgery)for gastric submucosal tumor [J]. Gastric Cancer, 2017, 20(3): 553-557.
[9] Onimaru M, Inoue H, Bechara R, et al. Clinical outcomes of per-oral endoscopic tumor resection for submucosal tumors in the esophagus and gastric cardia [J]. Dig Endosc, 2020, 32(3): 328-336.
[10] Nabi Z, Ramchandani M, Chavan R, et al. Endoscopic dissection of an esophageal submucosal tumor using a novel bipolar radiofrequency device [J]. Endoscopy, 2020, 52(7): E257-E258.
[11] Standards of Practice C, Faulx AL, Kothari S, et al. The role of endoscopy in subepithelial lesions of the GI tract [J]. Gastrointest Endosc, 2017, 85(6): 1117-1132.
[12] 沈琳, 曹晖, 秦叔逵, 等. 中国胃肠间质瘤诊断治疗共识[J]. 肿瘤综合治疗电子杂志, 2018, 4(1): 31-43. SHEN Lin, CAO Hui, QIN Shuikui, et al. Chinese consensus on diagnosis and treatment of gastrointestinal stromal tumors [J]. Journal of Multidisciplinary Cancer Management, 2018, 4(1): 31-43.
[13] Zhou P, Zhong Y, Li Q. Chinese consensus on endoscopic diagnosis and management of gastrointestinal submucosal tumor(version 2018)[J]. Zhonghua Wei Chang Wai Ke Za ZHi, 2018, 21(8): 841-852.
[14] Li B, Chen T, Qi ZP, et al. Efficacy and safety of endoscopic resection for small submucosal tumors originating from the muscularis propria layer in the gastric fundus [J]. Surg Endosc, 2019, 33(8): 2553-2561.
[15] Joo MK, Park JJ, Kim H, et al. Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract [J]. Gastrointest Endosc, 2016, 83(2): 318-326.
[16] Yang YT, Shen N, Ao F, et al. Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: a systematic review and meta-analysis [J]. Surg Endosc, 2020, 34(9): 3754-3765.
[17] 李琛, 谭玉勇, 乐梅先, 等. 内镜黏膜下剥离术治疗十二指肠病变的临床疗效分析[J]. 中华消化内镜杂志, 2010, 37(3): 190-4. LI Chen, TAN Yuyong, LE Meixian, et al. Efficacy of endoscopic submucosal dissection for duodenal lesions [J]. Chinese Journal of Digestive Endoscopy, 2010, 37(3): 190-194.
[18] Xiu H, Zhao CY, Liu FG, et al. Comparing about three types of endoscopic therapy methods for upper gastrointestinal submucosal tumors originating from the muscularis propria layer [J]. Scand J Gastroenterol, 2019, 54(12): 1481-1486.
[19] Cai MY, Martin Carreras-Presas F, Zhou PH. Endoscopic full-thickness resection for gastrointestinal submucosal tumors [J]. Dig Endosc, 2018(Suppl 1): 17-24. doi: 10.1111/den.13003.
[20] Xu HW, Zhao Q, Yu SX, et al. Comparison of different endoscopic resection techniques for submucosal tumors originating from muscularis propria at the esophagogastric junction [J]. BMC Gastroenterol, 2019, 19(1): 174.
[21] Du C, Chai N, Linghu E, et al. Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation [J]. Surg Endosc, 2018, 32(11): 4543-4551.
[22] Lv XH, Wang CH, Xie Y. Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors: a systematic review and meta-analysis [J]. Surg Endosc, 2017, 31(1): 49-63.
[23] Chen T, Zhang C, Yao LQ, et al. Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors [J]. Endoscopy, 2016, 48(2): 149-155.
[1] GUO Zhihua, ZHAO Daqing, XING Yuan, WANG Wei, LIANG Leping, YANG Jing, ZHAO Qianqian. Single-stage end-to-end anastomosis in the management of severe cervical tracheal stenosis [J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 72-76.
[2] XIAO Juan, XIAO Qiang, CONG Wei, LI Ting, DING Shouluan, ZHANG Yuan, SHAO Chunchun, WU Mei, LIU Jianing, JIA Hongying. Comparison of diagnostic efficacy of two kinds of thyroid imagine reporting and data systems [J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 53-59.
[3] WANG Bin, BU Xuehui, KONG Xianggen, ZHANG Zhaohua, WU Anzhao, XIAO Di, JIANG Xuemei. Comparison of the clinical characteristics between 37 adults and 10 children with COVID-19 [J]. Journal of Shandong University (Health Sciences), 2020, 58(10): 112-116.
[4] NIE Siyue, WANG Zhen, SUN Jingyu, LIU Jie, LI Juan, WEI Xiaojuan, LU Chunxiao, L(¨overU)Xingyan, WANG Shuyun, SUN Yuping. Expression and clinical significance of angiopoietin-like protein 5 in human gastric cancer tissues [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(8): 61-65.
[5] YAN Jinxiang, MENG Lei, DONG Yanan, ZHANG Aijun, YUE Hongsheng, LI Bo, ZHONG Liangjun, BAI Aiguo. Application of Solitaire FR stent in the optimized treatment of acute cerebral artery occlusion [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(7): 49-54.
[6] LU Ye, CUI Huifang, CHEN Xujun, HUANG Yihua, WU Yiqun, HUANG Jianlong, CHEN Huimin, XIONG Xianjun, CHEN Minghong. Application progress of freezing technology in intervention treatment of respiratory disease and preventive treatment for the correlated complications [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(4): 19-22.
[7] WANG Juan, ZHANG Hongtao, GAO Zhen, DI Xuemin, WANG Zeyang. Prevention and treatment of complications of abdominal tumor by radioactive seeds implantation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(2): 8-13.
[8] LIN Qi, ZHANG Ying, DAI Jianjian, XU Ruicai, YANG Qi, GENG Baocheng, HAN Mingyong. CT-guided 125I seed brachytherapy for superficial lymph node metastases: a report of 23 cases [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(2): 38-44.
[9] LIANG Fei, ZHANG Wenlong, ZHANG Jun, XU Chongen, ZOU Chengwei. Relevant factors and early complications of significantly elevated enzymes after off-pump coronary artery bypass grafting [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(10): 71-75.
[10] WANG Lili, HUO Bin, WANG Lei, WANG Hao, HOU Dingkun, HUO Xiaodong, WANG Jinhuan, ZANG Li, CAO Qiang, CHAI Shude, WANG Haitao. Meta-analysis and system evaluation of 125I implantation in the treatment of early lung cancer [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(10): 76-83.
[11] LIU Songtao, SHEN Bin, LIN Hui, LI Xiangwei, WEN Zhaoke. A comparative study of total thoracoscopic mitral valve replacement under heart beating and heart arrest [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 39-43.
[12] WANG Guangjie, ZU Shulu, ZHANG Xiulin, XU Zhishun, ZHOU Chunwen, LIU Yuqiang, WANG Shaoyong. Von Hippel-Lindau disease complicated with renal carcinoma: a report of 2 cases [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(2): 86-89.
[13] FANG Feifei, ZHANG Ying, LIN Qi, YUAN Yuan, DAI Jianjian, XU Ruicai, GENG Baocheng, HAN Mingyong. Clinical efficacy of CT-guided 125I seed brachytherapy in the treatment of metastatic hepatic carcinoma [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(12): 53-57.
[14] ZHAO Heng, YIN Qingfeng, LIU Wenguang, LIU Shenghou, XIAO Shipeng, WANG Shaojin. Application of a novel barbed suture in wound closure of hip and knee replacement [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(8): 53-56.
[15] YAO Dongxue, ZHAO Qi, QIN Chengyong. Clinical significance of miRNA-206 expression in gastric stromal tumor [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(12): 67-70.
Full text



No Suggested Reading articles found!