title: [Preliminary exploration on submucosal tunneling endoscopic resection for middle and lower esophagus submucosal tumors].
abstract: OBJECTIVE
  To evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) in the treatment of middle and lower esophagus submucosal tumors (SMT) originating from muscularis propria (MP) layer.
  
  
  METHODS
  A total number of 33 esophagus submucosal tumor (SMT) originating from MP layer underwent tumor resection by STER after endoscopic ultrasonography (EUS) and CT examination at Endoscopy Center, Department of Gastroenterology, First Affiliated Hospital, Nanjing Medical University from March 2012 to March 2013. There were 17 males and 16 females with an age range of (50 ± 10) years. Their lesion size, lesion origin, pathology, operative duration and complication rate were analyzed.
  
  
  RESULTS
  Among them, the origins were of submucosal (n = 4, 12.1%), superficial muscularis propria layer (SMP) (n = 18, 54.6%), deep muscularis layer (DMP) (n = 10, 30.3%) and serosa (n = 1, 3.0%). There were single tumor (n = 30, 90.9%), double tumors (n = 2, 6.1%) and triple tumors (n = 1, 3.0%). Except for 1 case of non-resected hemangioma, 36 operative specimens were examined pathologically, including 30 leiomyomas tumors (83.3%), 5 stromal tumors (GIST) (13.9%) and 1 lipoma tumor (2.8%). Thirty-two lesions were successfully resected by STER with a complete resection rate of 97.0%. Average lesion size was (1.7 ± 1.0) cm and average operative duration (49 ± 26) min. A number of (7.8 ± 2.5) hemostatic clips were used to close the mucosal incision site. Subcutaneous emphysema occurred in 3 patients (9.1%) while puncture and pneumothorax developed in one case (3.0%). All of them recovered uneventfully through conservative treatments.
  
  
  CONCLUSIONS
  As a new safe, efficacious and feasible treatment for middle and lower esophagus submucosal tumors, STER may completely resect SMT and provide accurate histopathological evaluations. And it is feasible to regain the mucosal integrity of GI tract and prevent the occurrences of leakage and secondary infections.
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
authors.forename: Chun-hua
authors.initials: CH
authors.lastname: Jiao
authors.forename: Shu-ping
authors.initials: SP
authors.lastname: Yang
authors.forename: Xue-liang
authors.initials: XL
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Ding
authors.forename: Ying-hong
authors.initials: YH
authors.lastname: Xu
authors.forename: Gui
authors.initials: G
authors.lastname: Tao
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.forename: Dao-quan
authors.initials: DQ
authors.lastname: Zhang
authors.forename: Xiang
authors.initials: X
authors.lastname: He
authors.forename: Wang-kai
authors.initials: WK
authors.lastname: Chen
authors.forename: Rui-hua
authors.initials: RH
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D016145:Endoscopy, Digestive System / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult