Endoscopic Submucosal Dissection for Gastric Subepithelial Tumors: A Single-Center Experience.
Background and Aims. Endoscopic submucosal dissection (ESD) has been accepted as a treatment modality for gastrointestinal epithelial tumors. Recently, ESD has been applied to resect subepithelial tumors (SETs) in the gastrointestinal tract, but clinical evidence on its efficacy and safety is limited. The aim of this study was to investigate the efficacy and safety of ESD for gastric SETs and to assess possible predictive factors for incomplete resection. Patients and Methods. Between January 2006 and December 2013, a total of 49 patients with gastric SET underwent ESD at our hospital. Clinicopathologic characteristics of patients and SETs, therapeutic outcomes, complications, and follow-up outcomes were evaluated. Results. The overall rates of en bloc resection and complete resection were 88% (43/49) and 84% (43/49), respectively. Complete resection rates in tumors originating from the submucosal layer were significantly higher than those in tumors originating from the muscularis propria layer (90% versus 56%, P = 0.028). In multivariate logistic regression analyses, tumor location (upper third: odds ratio [OR] 12.639, 95% confidence interval [CI] 1.087-146.996, P = 0.043) and layer of tumor origin (muscularis propria: OR 8.174, 95% CI 1.059-63.091, P = 0.044) were independently associated with incomplete resection. Procedure-related bleeding and perforation rates were both 4%. No recurrence was observed in patients with complete resection at a median follow-up period of 29 months (range: 7-83 months). Conclusions. ESD is an effective, safe, and feasible treatment for gastric SETs. The frequency of incomplete resection increases in tumors located in the upper third of the stomach and in those originating from the muscularis propria layer.
Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea.
Jin Sung
JS
Lee
Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea.
Gwang Ha
GH
Kim
Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea ; Department of Pathology, Pusan National University School of Medicine, Busan 602-739, Republic of Korea.
Do Youn
DY
Park
Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea.
Jong Min
JM
Yoon
Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea.
Tae Wook
TW
Kim
Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea.
Jong Hun
JH
Seo
Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea.
Bong Eun
BE
Lee
Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, Republic of Korea.
Geun Am
GA
Song