title: Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video).
abstract: BACKGROUND
  Given the high morbidity and mortality rates for surgery and the diminishment of quality of life caused by operative resection of the gastric cardia, a minor invasive treatment without loss of curability is desirable for submucosal tumors (SMTs) of the esophagogastric junction (EGJ). Endoscopic submucosal dissection (ESD) has been used successfully for the removal of esophageal or gastric SMTs; however, the EGJ has been regarded as a difficult location for ESD because of its narrow lumen and sharp angle.
  
  
  OBJECTIVE
  To evaluate the clinical impact of ESD for SMTs of the EGJ arising from the muscularis propria layer.
  
  
  METHODS
  Single-center, prospective study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  143 patients with 143 SMTs of the EGJ originating from the muscularis propria layer.
  
  
  METHODS
  ESD.
  
  
  METHODS
  Complications, en bloc resection rate, local recurrence, and distant metastases.
  
  
  RESULTS
  The average maximum diameter of the lesions was 17.6 mm (range 5 - 50 mm). The en bloc resection rate was 94.4% (135/143). All en bloc resection lesions showed both lateral and deep tumor-free margins, including 20 GI stromal tumors. Perforations occurred in 6 patients (4.2%, 6/143), and metal clips were used to occlude the defect. Four pneumoperitoneum and 2 pneumothorax caused by perforations were resolved with nonsurgical treatment. Local recurrence and distant metastasis have not occurred during a 2-year follow-up.
  
  
  CONCLUSIONS
  Single-center, short follow-up.
  
  
  CONCLUSIONS
  ESD appears to be a safe, feasible, and effective procedure for providing accurate histopathologic evaluations, as well as curative treatments for SMTs of the EGJ originating from the muscularis propria layer.
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Quan-Lin
authors.initials: QL
authors.lastname: Li
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.forename: Shi-Yao
authors.initials: SY
authors.lastname: Chen
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Ma
authors.forename: Wen-Zheng
authors.initials: WZ
authors.lastname: Qin
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D016586:Granular Cell Tumor / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008067:Lipoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D011027:Pneumoperitoneum / Q000209:etiology / Q000628:therapy; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult