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Effect of Submucosal Tunneling Endoscopic Resection for Submucosal Tumors Originating From the Muscularis Propria Layer in the Esophagogastric Junction and Risk Factors for Failure of En Bloc Resection: 2017 Presidential Poster Award


Li, Zhenjuan MS; Gao, Ying MM; Chai, Ningli MD, PhD; Xiong, Ying MD; Ma, Lianjun MD; Zhang, Wengang MS; Du, Chen MS; Linghu, Enqiang MD, PhD; Lu, Zhongsheng MM; Wang, Xiangdong MB; Tang, Ping MB

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S679-S680
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Introduction: Most submucosal tumors(SMTs) in the esophagogastric junction (EGJ) are irregularly shaped and different from those in the esophagus where submucosal tunneling endoscopic resection(STER) has been proven effective and safe. However, few reports paid attention to STER for SMTs in the EGJ. The aim of the study was not only to evaluate the effect of STER in patients with SMTs in the EGJ but to analyze the risk factors for en bloc resection failure.

Model shape of SMTs originating from the Laimer fiber at EGJ.
An irregularly-shaped SMT suspected of originating from the Laimer fiber.
Table. Characteristics and clinical outcomes of 47 patients with submucosal tumors treated by STER

Methods: A consecutive of 47 patients with SMTs originating from the MP layer in the EGJ underwent STER were retrospectively included between September 2012 to December 2016.Thirty-five tumors underwent en bloc resection and the other 12 tumors received piecemeal resection. The tumor size operation time en bloc resection rate complications residual and local recurrence were achieved and compared between the two groups.

Results: Forty-six of 47 lesions (97.9%) were successfully resected. The mean lesion size was (29.7±16.3) mm. Both the en bloc resection rate and complete resection rate were 74.5% (35/47).No severe complications occurred in the 47 patients. Patients in the piecemeal resection group had more irregularly shaped lesions, longer tumor diameters, larger tumor size (≥40 mm), longer operation time and longer hospital stay after procedure (P<0.05) and there were no statistically differences between the two groups in inoperative, post-operative complications and residual rate (P>0.05). By univariate analysis and logistic regression analysis, irregular shape and tumor diameter≥20 mm were two risk factors for en bloc resection failure.

Conclusion: STER is an effective and safe technique for the treatment of SMTs arising from the MP layer in the EGJ. Irregular shape and tumor diameter ≥20 mm are the reliable risk factors for en bloc resection failure.

Table. Comparison of characteristics of 47 patients with SMTs treated by STER under en bloc resection and piecemeal resection
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