title: Heading toward the right direction--solution package for endoscopic submucosal tunneling resection in the stomach.
abstract: BACKGROUND
  The emerging submucosal tunneling and endoscopic resection (STER) technique provides definitive histological diagnosis as well as a therapeutic method for the gastric submucosal tumors (SMTs). We aim to present our experience and discuss key technical issues of STER.
  
  
  METHODS
  45 patients with gastric SMTs arising from MP received STER. First, a mucosal incision was made 3 cm proximal to the tumour, a submucosal tunnel was subsequently built from the incision to the tumor. The tumor was gradually exposed and dissected from surrounding tissue and retrieved from the tunnel. The initial mucosal incision was closed by metal clips. For SMTs in the gastric fundus near cardia, the submucosal tunnel was built from lower esophagus, through the angle of His, to the tumor for resection.
  
  
  RESULTS
  STER was successfully performed in 43 patients; the other two were converted to surgery. Mean operating time was 79.3 min (range 45-150 min). Mean tumor size was 1.4 cm (range 0.5-5 cm). Of the total 47 resected SMTs, 36 were GISTs, 10 were leiomyomas and 1 was schwannoma. Complete resection was achieved in all patients. Intra-procedural peumoperitoneum occurred in 3 cases because of iatrogenic perforation, no special treatment was given. 7 patients presented with mild abdominal pain/distention and fever were given antibotics. No severe post-operative complication happened. No tumor recurrence occurred in the median 11 month follow-up period.
  
  
  CONCLUSIONS
  Based on short-term follow-up observation, STER is a feasible, safe and minimally invasive method for the diagnosis and treatment of small (<3 cm) SMTs in gastric body, antrum and proximal cardia.
authors: Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China; Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors: Jiaoyang
authors: J
authors: Lu
authors: Department of Statistics, Shandong Provincial Hospital, Jinan, Shandong, China.
authors: Taotao
authors: T
authors: Jiao
authors: Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China.
authors: Yanmei
authors: Y
authors: Li
authors: Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China.
authors: Ying
authors: Y
authors: Liu
authors: Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China.
authors: Yanan
authors: Y
authors: Wang
authors: Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China.
authors: Yatian
authors: Y
authors: Wang
authors: Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors: Minhua
authors: M
authors: Zheng
authors: Department of Gastroenterology, Qilu Hospital, Shandong University School of Medicine, Jinan, Shandong, China.
authors: Xuefeng
authors: X
authors: Lu
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005748:Gastric Fundus / Q000473:pathology; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*