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Current Status of Endoscopic Resection of Gastric Subepithelial Tumors

Chen, Huimin, MD, PhD1,3; Li, Baiwen, MD, PhD1,4; Li, Lianyong, MD, PhD1,5; Vachaparambil, Cicily T., MD1; Lamm, Vladimir, MD1; Chu, Yuan, MD2; Xu, Meidong, MD, PhD6; Cai, Qiang, MD, PhD, FACG1

American Journal of Gastroenterology: May 2019 - Volume 114 - Issue 5 - p 718–725
doi: 10.14309/ajg.0000000000000196

Most gastrointestinal (GI) subepithelial tumors (SETs) are identified incidentally during endoscopic examination and are located in the stomach. Some SETs are malignant or have the potential to become malignant. Tumors originating from deeper layers, such as the muscularis propria or serosa, are not easy to diagnose and resect. Current guidelines recommend yearly endoscopic surveillance of SETs smaller than 2 cm. This recommendation may not be cost-effective in managing GI SETs. Endoscopic resection results not only in obtaining sufficient tissue for pathological diagnosis but also in resection and curing the tumor. Many different endoscopic methods for resection of GI SETs have been published in the literature. To avoid confusion, we have divided these methods into standard endoscopic submucosal dissection, modified endoscopic submucosal dissection, submucosal tunneling endoscopic resection, and nonexposed and exposed endoscopic full-thickness resection. These procedures offer less invasive approaches than surgery for resection of GI SETs and may be the most cost-effective in taking care of patients with GI SETs.

1Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA;

2Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China;

3Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China;

4Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;

5Department of Gastroenterology, PLA 306th Hospital, Beijing, China.

6Endoscopic Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.

Correspondence: Qiang Cai, MD, PhD, FACG. E-mail: Meidong Xu, MD, PhD. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at,,, and

Received April 02, 2018

Accepted December 14, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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