Clinical Observasion of Endoscopic Submucosal Dissection for Flat Polyp and Submucosal Tumor of Gastrointestinal Tract

Objective To assess the clinical efficacy and safety of endoscopic submucosal dissection(ESD) for flat polyp and submucosal tumor(SMT) of the gastrointestinal tract. Methods Total 58 patients with mucosal tumor of the gastrointestinal tract diagnosed by endoscopy were examined using endoscopic ultrasonography(EUS). Among the cases, 25 lesions were within the submucosa, 16 lesions were within the submucosa muscularis and 17 in the submucosa propria. The cases were managed by ESD with a HOOK and IT knife. After injection of physiological saline solution into the submucosal layer to separate the lesion from the muscle layer, the mucosa surrounding the lesion was pre-cut, and the connective tissue of the submucosa beneath the lesion was dissected. Then, the lesion was resected completely. Results All lesions were successfully resected with ESD. The resected lesions sized 0.4~3.4 cm in diameter(mean,1.5 cm). The mean ESD procedure time was 40 min(ranged from 15 to 95 min). None of the patients showed delayed bleeding after ESD. Histological evaluation showed that the tunica of the tumors was intact, and both the lateral and basal margins of the specimens were free of tumor cells. Conclusion ESD is an efficacious and safe procedure for the treatment of SMT of the gastrointestinal tract. It is possible to completely resect submucosal lesions and provide sufficient pathological information.