Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video)

Background: Endoscopic submucosal dissection (ESD) is a well-accepted method for removing superficial mucosa( tumors; however, there is limited data on the use of this method for removing subepithelial tumors. Objective: To investigate the efficacy, safety, and outcome of EST) for gastric subepithelial tumors and determine factors related to treatment success. Design: Retrospective analysis of a prospectively maintained database. Setting: Single tertiary academic center. Patients and Interventions: From April 2007 to November 2010, 37 patients with gastric subepithelial tumors were treated with ESD. Main Outcome Measurements: Macroscopically and microscopically complete en block resection rate (R0), complication rate, and endosonographic features predictive of R0 resection. Results: The median tumor diameter was 25.0 mm, (range 10-60 mm, IQR 17-37). The overall rate of R0 resections was 81.1% (30/37, 95%CI: 61.8-90.2%), including 100% (15/15, 95%CI: 78.2-100.0%) of tumors from the submucosa and 68.2% (15/22, 95%CI: 45.1-86.1%) of tumors from the muscularis propria. Seventeen patients had a final diagnosis of gastrointestinal stromal tumor. The severe complication (perforation) rate was 5.4% (2/37, 95%CI: 0.0-9.5%). One patient required surgery; the other was treated conservatively. No recurrence was observed in patients with 120 resections at a median follow up of 21.0 months (IQR 11-35). Successful R0 resections were predicted by the observation of no, or only narrow, tumor connections with the underlying muscle layer during EUS (OR=35.0, 95%CI: 3.7-334.4, p=0.001). Limitations: Single-center, retrospective analysis, short follow-up. Conclusions: ESD is an effective and relatively safe method for removing gastric subepithelial tumors. Endoscopic ultrasonography findings can predict complete tumor resections. (Gastrointest Endosc 2012;75:276-86.)