Analysis of submucosal tunneling endoscopic resection on treatment of esophageal submucosal tumors

Objective To investigate the optimal indication of submucosal tunneling endoscopic resection (STER) in patients with esophageal submucosal tumor (SMT). Methods Clinical data of 67 patients with esophageal SMT from May 2013 to August 2014 were summarized in the Digestive Endoscopy Center of Shanghai Changhai Hospital, and relationships between lesion features and success rate or complications of STER were analyzed. Results Of all 67 cases, 60 cases (89.6%) located in the middle and low segment of the esophagus, 64 cases (95.6%) were endo-luminal growth. The maximum diameter of lesions were ranged from 1 to 6 cm with mean length of (2.34±1.13) cm. The length of tunnel incision was 1-2 cm with mean length of (1.19±0.37) cm, and the length of submucosal tunnel was 2-7 cm with mean length of (4.09±1.26) cm. The mucosal injury rate and muscularis propria injury rate was 7.5% (5/67) and 4.5% (3/67), respectively. The number of hemostatic clips for tunnel incision closure was 2-17 with mean number of 8.79±3.39. No delayed hemorrhage or severe adverse events occurred in any of the 67 patients following STER. The success rate of STER was 100%. The en bloc resection rate was 91.0% (61/67), while the en bloc removal rate was 83.6% (56/67). When the maximum diameter of lesions was more than 3 cm, the operation time increased significantly, while the en bloc resection or removal rates were declined. Conclusion STER is safe and effective for esophageal SMT, especially for lesions located in the middle and low segment esophagus with less than 3 cm maximum diameter. Key words: Esophageal neoplasms; Submucosal tumors; Submucosal tunneling endoscopic resection