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Safety and Efficacy of Endoscopic Excavation for Gastric Subepithelial Tumors Originating From the Muscularis Propria Layer: Results From a Large Study in China

Zhang, Yu MM; Ye, Li-Ping BM; Zhou, Xian-Bin MM; Mao, Xin-Li MM; Zhu, Lin-Hong MM; He, Bi-Li MM; Huang, Qin MM

Journal of Clinical Gastroenterology: September 2013 - Volume 47 - Issue 8 - p 689–694
doi: 10.1097/MCG.0b013e3182908295
ALIMENTARY TRACT: Original Articles

Background and Aim: In this retrospective study, we investigated the safety and efficacy of endoscopic excavation of gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer.

Materials and Methods: Between November 2007 and June 2012, 212 patients with gastric SETs originating from the MP layer were treated via endoscopic excavation. The key procedures were: (1) injecting a mixture solution (100 mL saline+2 mL indigo carmine+1 mL epinephrine) into the submucosa around the tumor; (2) making a cross-incision of the mucosa and then excavating the tumor by the technique of endoscopic excavation. After the tumor was completely excavated from the MP layer, it was removed using a snare; (3) closing the artificial ulcer with clips.

Results: The mean diameter of the 212 tumors was 16.5 mm. Complete resection by endoscopic excavation was achieved in 204 cases (96.2%). The rate of complete resection was significantly higher for tumors <2 cm (98.0%) than for tumors >2 cm (91.9%) (P=0.035). Perforation occurred in 32 cases (15.1%), and massive bleeding occurred in 9 cases (4.2%) during the procedure. The rate of perforation was significantly higher for the fundus and the body than for antrum (21.5%, 11.5%, 0%, respectively; P=0.036), and also differed significantly in relation to histologic diagnosis (23.7% for gastrointestinal stromal tumors vs. 7.8% for leiomyoma; P=0.001). Histologic diagnosis showed that the density of gastrointestinal stromal tumors located in the fundus and the body of the stomach was significantly higher than in the antrum (44.1%, 51.9%, 13.3%, respectively; P=0.036).

Conclusions: Endoscopic excavation is a safe and efficient method for resecting small (>3.5 cm) gastric SETs originating from the MP layer.

Supplemental Digital Content is available in the text.

Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China

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The authors declare that they have nothing to disclose.

This retrospective study was approved by the ethics committee of the Taizhou Hospital, Wenzhou Medical College.

Reprints: Li-Ping Ye, BM, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai 317000, Zhejiang Province, China (e-mail:

Received July 27, 2012

Accepted March 5, 2013

© 2013 by Lippincott Williams & Wilkins