title: Safety of Endoscopic Resection for Upper Gastrointestinal Subepithelial Tumors Originating from the Muscularis Propria Layer: An Analysis of 733 Tumors.
abstract: OBJECTIVE
  Although endoscopic resection is an accepted technique for upper gastrointestinal subepithelial tumors (SETs) originating from the muscularis propria (MP) layer, published data regarding its complications are highly variable and limited to small data series. This study aimed to analyze the safety of endoscopic resection in a large case series.
  
  
  METHODS
  A total of 726 consecutive patients with 733 upper gastrointestinal SETs originating from the MP layer underwent endoscopic resection from June 2005 to December 2014. The complete resection rate, perioperative perforation rate, and perioperative bleeding rate were the main outcome measurements.
  
  
  RESULTS
  The complete resection rate was 97.1%. Ninety-four patients had complications (12.9%), including 88 with perioperative perforations (12.1%), 13 with perioperative bleeding (1.8%), 5 with localized peritonitis (0.7%), and one with delayed bleeding (0.1%). Eleven patients required surgery; the others were treated endoscopically. Risk factors for incomplete resection were extensive connection of the tumor to the MP layer (P=0.007) and extraluminal growth (P=0.048). Risk factors for perioperative perforation were larger tumor size (≤2.0 cm vs. 2.1-3.0 cm vs. >3.0 cm, P=0.021), extraluminal growth (P=0.046), and extensive connection (P<0.001). A risk factor for perioperative bleeding was larger tumor size (P=0.045). No residual or recurrent lesions were detected during the follow-up period (median: 28 months).
  
  
  CONCLUSIONS
  Endoscopic resection is an effective and reasonably safe therapeutic method for treating/removing upper gastrointestinal SETs originating from the MP layer when managed by an experienced endoscopic team.
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Ye
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Ding-Hai
authors.initials: DH
authors.lastname: Luo
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Xin-Li
authors.initials: XL
authors.lastname: Mao
authors.affiliation: Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Hai-Hong
authors.initials: HH
authors.lastname: Zheng
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Xian-Bin
authors.initials: XB
authors.lastname: Zhou
authors.affiliation: Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Lin-Hong
authors.initials: LH
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome