Use of endoscopic ultrasound-guided injection in endoscopic resection of solid submucosal tumors

Aims: Submucosal tumor (SMT) is a common disease. We used endoscopic ultrasound (EUS)-guided puncture to inject saline before resection of SMTs, and evaluated the usefulness of this method. Patients and Methods: We selected 16 symptomatic patients with solid SMTs in the upper gastrointestinal tract, confirmed by endoscopy and EUS. We first used EUS-guided puncture to inject saline to separate the submucosal lesions from the deeper normal tissues. Lesions in the muscularis mucosa and submucosa were then removed directly by snare cauterization. Lesions in the muscularis propria were treated by means of a two-step approach: first, we incised the superficial tissue of the tumors using an electrosurgical needle, and second, we enucleated SMTs as much as possible by tightening the snare around them and creating pseudo-stalks. After snare excision of SMTs, the cleavages of the superficial tissues were closed using metal clips. Results: Among the 16 patients, one lesion was in the muscularis mucosa, six were in the submucosa, and nine were in muscularis propria. All the lesions were resected thoroughly. No perforation occurred nor had any recurrences been observed at follow-up of 12 - 17 months. Conclusions: EUS-guided puncture to inject saline before resection is a safe and accurate procedure in the treatment of submucosal tumors.