title: Submucosal tunneling endoscopic resection for submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a feasibility study (with videos).
abstract: BACKGROUND
  The esophagogastric junction (EGJ) is a difficult location for endoscopic resection due to its narrow lumen and sharp angle. Potential increased risks of perforation and mediastinal infection exist, especially for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. We previously demonstrated the safety and efficacy of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal SMTs, but the feasibility of STER for the removal of SMTs at the EGJ requires systematic investigation. The aim of the investigation was to evaluate the clinical impact of STER on the removal of SMTs at the EGJ.
  
  
  METHODS
  A prospective study was carried out which included a consecutive cohort of 57 patients who underwent STER for 57 SMTs of the EGJ originating from the MP layer between July 2010 and August 2012 in a single academic medical center. Adverse events, en bloc resection rate, and local recurrence were evaluated.
  
  
  RESULTS
  The average maximum diameter of the lesions was 21.5 mm (range 6-35 mm). The en bloc resection rate was 100 % (57/57). No delayed hemorrhage or severe adverse events occurred in any of the 57 patients following STER. No local recurrence and distant metastasis occurred during 24 months' follow-up. Less subcutaneous emphysema and pneumomediastinum absorption time (p = 0.005) occurred with CO2 versus air insufflations.
  
  
  CONCLUSIONS
  Our study showed that STER was safe and effective, provided accurate histopathologic evaluation, and was curative for SMTs of the deep MP layers at the EGJ. CO2 gas insufflation is recommended.
authors: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.
authors: Xiao-Yun
authors: XY
authors: Wang
authors: Mei-Dong
authors: MD
authors: Xu
authors: Li-Qing
authors: LQ
authors: Yao
authors: Ping-Hong
authors: PH
authors: Zhou
authors: Douglas
authors: D
authors: Pleskow
authors: Quan-Lin
authors: QL
authors: Li
authors: Yi-Qun
authors: YQ
authors: Zhang
authors: Wei-Feng
authors: WF
authors: Chen
authors: Yun-Shi
authors: YS
authors: Zhong
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D009130:Muscle, Smooth / Q000473:pathology / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies