title: [Preliminary experience with endoscopic gastric submucosal tumor resection through the submucosal tunnel using double tunnel and double flex endoscope].
abstract: OBJECTIVE
  To examine the feasibility and safety of gastric submucosal tunnel dissection of gastric submucosal tumors (SMTs) by double tunnel and double flex endoscope.
  
  
  METHODS
  Fifty patients with gastric SMTs detected by gastric endoscopy and endoscopic ultrasonography between January, 2012 and August, 2013 were enrolled in this study. Using carbon dioxide throughout the procedure, the mucous in the arc was incised along the margins of the lesion to separate the submucosa and create a tunnel. The exposed SMTs were resected completely and the mucosa was covered by endoscopic forceps followed by clipping of the incision. The complication, clinical outcomes, hospital stays and operation time were evaluated.
  
  
  RESULTS
  Of the 50 lesions, 50 were located in the gastric fundus, 17 in the gastric antrum and 5 in the gastric body. The lesions were completely resected in all the patients. The diameter of the resected lesions ranged from 0.5 to 2.5 cm (mean 1.1 ± 0.6 cm), and the operation lasted for 35.3 ± 16.2 min (range 23-76 min). In 5 cases (10%), perforation occurred during the operation and was closed by clipping the incision with endoclips after the lesion resection; these patients were discharged after conservative management. Intraoperative bleeding occurred in 16 cases and was successfully managed through endoscopic methods. No delayed postoperative bleeding or perforation occurred in these patients. None of the 48 patients followed up showed tumor recurrence at one year after the operation, and 2 patients were lost for follow up.
  
  
  CONCLUSIONS
  Endoscopic submucosal dissection of gastric SMTs is effective and safe using double tunnel and double flex endoscope.
authors.affiliation: Department of Digestive Diseases, General Hospital of PLA, Beijing 100853, China.E-mail: xy_spring@163.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xiong
authors.forename: Haiqing
authors.initials: H
authors.lastname: Hu
authors.forename: Aimin
authors.initials: A
authors.lastname: Wang
authors.forename: Enqiang
authors.initials: E
authors.lastname: Linghu
authors.forename: Yuanping
authors.initials: Y
authors.lastname: Li
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Geng
mesh_terms: D004210:Dissection; D019723:Endoscopes; D004724:Endoscopy; D019160:Endosonography; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006801:Humans; D009364:Neoplasm Recurrence, Local; D013274:Stomach Neoplasms / Q000601:surgery*