title: Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up: a prospective study of 224 cases in a single medical center.
abstract: Diagram, diagnosis, and treatment with endoscopic submucosal dissection (ESD) for upper gastrointestinal submucosal tumors (SMTs) remain controversial, although endoscopic ultrasonography (EUS) and ESD have been established in diagnosis and treatment of SMTs in decades, respectively. In this study, we have investigated prospectively the profile of upper gastrointestinal SMTs, assessed the effect and feasibility of ESD in upper gastrointestinal SMTs treatment, as well as value of EUS in pre-ESD diagnosis and post-ESD follow-up for gastrointestinal SMTs.
  
  
  
  The upper gastrointestinal SMTs patients detected with endoscopy were further checked by EUS, then received series ESD treatment, and fulfilled 3- and 12-month follow-up EUS detection between July 2011 and March 2015. The parameters of SMTs with EUS examination (size, original layer) and treatment with ESD (en bloc resection rate, procedure time, procedure-related complications) were investigated and analyzed.
  
  
  
  A total number of 224 patients with upper gastrointestinal SMTs were enrolled, and 108 (48.2 %) were men. The mean age was 50.4 ± 12.0 years (range 19-77 years). In total, 92 (41.1 %), 14 (6.3 %), 61 (27.2 %), 22 (9.8 %), 25 (11.2 %), and 10 (4.5 %) SMTs were located in esophagus, cardiac, fundus, body and antrum of stomach, duodenum, respectively. Two hundred and eight (92.9 %) patients were successfully treated with an en bloc ESD, while other 16 patients (7.1 %) suffered ESD failure (5.3 %, 12 case) or severe complications (1.8 %, 4 cases). The mean procedure time of ESD was 47.4 ± 27.3 min (range 10-180 min). The mean size of the SMTs measured with ESD samples was 13.6 ± 9.5 mm (range 4-113 mm). In total, 87 (38.8 %), 23 (10.3 %), and 114 (50.9 %) tumors originated from muscularis mucosa, submucosa, and muscularis propria, respectively. The majority of SMTs were leiomyoma (109, 48.7 %) and gastrointestinal stromal tumors (GIST) (77, 34.4 %), while other SMTs were confirmed as ectopic pancreas (21, 9.4 %), adenoid tumor (8, 3.6 %), lipoma (5, 2.2 %), neuroendocrine tumor (3, 1.3 %), and granulosa cell tumor (1, 0.4 %). The accuracy rate of EUS in pathological diagnosis or original layer was 82.6 % (185/224) or 74.6 % (167/224). Residual tumors were detected with EUS in 3 patients (1.3 %) in 3-month follow-up and no recurrence during 12-month follow-up period.
  
  
  
  The predominant SMTs in upper gastrointestinal tract were leiomyoma in esophageal tumors which originated from muscularis mucosae and GIST in stomach which originated from muscularis propria detected satisfactorily with EUS. This study showed that ESD was a safe and effective treatment for upper gastrointestinal SMTs.
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Ganqing
authors.initials: G
authors.lastname: He
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Jinhui
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Baili
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Xiangbin
authors.initials: X
authors.lastname: Xing
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Jinping
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Endoscopy Center, Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China. minhuch@yeah.net.
authors.forename: Minhu
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002828:Choristoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D004724:Endoscopy; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006106:Granulosa Cell Tumor / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008067:Lipoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009130:Muscle, Smooth; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010179:Pancreas; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: Efficacy; Endoscopic; Submucosal tumor; Ultrasonography
references.citation: Gastrointest Endosc Clin N Am. 2005 Jul;15(3):455-66, viii
references.pmid: 15990051
references.citation: Br J Surg. 2003 Oct;90(10):1178-86
references.pmid: 14515284
references.citation: Best Pract Res Clin Gastroenterol. 2009;23 (5):679-701
references.pmid: 19744633
references.citation: Gut. 2001 Feb;48(2):225-9
references.pmid: 11156645
references.citation: Gastrointest Endosc. 2002 Oct;56(4 Suppl):S43-8
references.pmid: 12297748
references.citation: J Gastroenterol Hepatol. 2008 Aug;23 (8 Pt 2):e318-24
references.pmid: 18505417
references.citation: Gastrointest Endosc. 2012 Jun;75(6):1153-8
references.pmid: 22459663
references.citation: Endoscopy. 1994 May;26(4):352-8
references.pmid: 8076567
references.citation: Surg Endosc. 2013 Sep;27(9):3271-9
references.pmid: 23519491
references.citation: Gastroenterology. 2006 Jun;130(7):2217-28
references.pmid: 16762644
references.citation: Endoscopy. 2010 Apr;42(4):324-6
references.pmid: 20354943
references.citation: World J Gastroenterol. 2015 Jan 14;21(2):578-83
references.pmid: 25593479
references.citation: World J Gastrointest Endosc. 2015 Mar 16;7(3):192-205
references.pmid: 25789089
references.citation: Surg Endosc. 2011 Feb;25(2):468-74
references.pmid: 20589510
references.citation: Dig Dis Sci. 2013 Jun;58(6):1710-6
references.pmid: 23381103
references.citation: Dig Endosc. 2009 Oct;21(4):266-9
references.pmid: 19961528
references.citation: Scand J Gastroenterol. 2002 Jul;37(7):856-62
references.pmid: 12190103
references.citation: Gastroenterology. 2004 Jan;126(1):301-7
references.pmid: 14699508
references.citation: Endoscopy. 2009 Apr;41(4):329-34
references.pmid: 19340737
references.citation: Gastrointest Endosc Clin N Am. 2005 Jan;15(1):33-54, viii
references.pmid: 15555950
references.citation: J Natl Compr Canc Netw. 2010 Apr;8 Suppl 2:S1-41; quiz S42-4
references.pmid: 20457867
references.citation: Surg Endosc. 1991;5(1):20-3
references.pmid: 1871670
references.citation: Gastrointest Endosc. 2009 Jun;69(7):1228-35
references.pmid: 19249769
references.citation: Gastrointest Endosc. 2010 May;71(6):913-9
references.pmid: 20226456
references.citation: Gastrointest Endosc. 1999 Oct;50(4):560-3
references.pmid: 10502182
references.citation: Gastrointest Endosc. 2012 Feb;75(2):276-86
references.pmid: 22032850
references.citation: Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1281-6
references.pmid: 19950778
references.citation: Gastrointest Endosc. 2011 Dec;74(6):1194-200
references.pmid: 21963065
references.citation: Surg Endosc. 2011 Sep;25(9):2926-31
references.pmid: 21424195
references.citation: Endoscopy. 2010 Apr;42(4):292-9
references.pmid: 20354939