title: Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors.
abstract: OBJECTIVE
  Submucosal tunneling endoscopic resection (STER) has become a potential option for the endoscopic treatment of a selected group of patients with submucosal tumors (SMTs) originating from the muscularis propria layer in the upper gastrointestinal tract. The aim of this retrospective study was to analyze the incidence and management of STER-related complications.
  
  
  METHODS
  From January 2011 to August 2013, 290 patients with upper gastrointestinal SMTs treated by STER were included in the study. Clinicopathological characteristics and complication data were collected and analyzed retrospectively.
  
  
  RESULTS
  Mucosal injury occurred in three cases (1.0 %) and major bleeding occurred in five cases (1.7 %). The gas-related complications were very common; however, only nine cases of major pneumothorax (> 30 % lung collapse) needed therapeutic intervention (3.1 %). Thoracic effusion occurred in 49 patients, 11 of whom had low grade fever or segmental atelectasis that required thoracentesis and drainage (3.8 %). Thus, although the overall incidence of complications was 23.4 % (68/290), only 10.0 % of procedures (29/290) required intervention for complications. Based on the statistical analysis, irregular shape, tumor in the deep muscularis propria layer, long procedure time, and air insufflation were risk factors of STER-related major complications.
  
  
  CONCLUSIONS
  Although the incidence of STER-related complications was relatively high, most of these complications were minor and did not require therapeutic intervention. STER is a safe technique for the treatment of upper gastrointestinal SMTs.
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Quan-Lin
authors.initials: QL
authors.lastname: Li
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ming-Yan
authors.initials: MY
authors.lastname: Cai
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D019468:Disease Management; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult