Endoscopic submucosal resection of gastric subepithelial lesions smaller than 20 mm: a comparison of saline solution-assisted snare and cap band mucosectomy techniques.
OBJECTIVE
Application of endoscopic submucosal resection (ESMR) in the management of gastric subepithelial lesions (GSLs) less than 20 mm is gradually increasing because it allows diagnosis and treatment at the same operative session. In this study, we compare and evaluate the benefits of ESMR with an endoscopic cap band mucosectomy technique or saline solution-assisted snare technique in GSLs smaller than 20 mm.


METHODS
This was a retrospective analysis of a prospectively maintained database used at 2 academic tertiary care centers. A total of 63 patients (34 females, mean age 52 years) with endoscopically resected GSLs were included in this study.


RESULTS
The mean tumor size determined by EUS was 12.3 mm (range, 5-20 mm). Sixty-seven percent of the GSLs were localized in the antrum in all groups. The endoscopic cap band mucosectomy technique was used to resect 32 (50.8%) GSLs, whereas 31 (49.2%) were resected with the saline solution-assisted snare technique. The en bloc resection rates were 97% for the saline solution-assisted snare technique and 100% for the endoscopic cap band mucosectomy. Intraoperative bleeding occurred in 1 of 31 patients (3.2%) when ESMR was performed with the saline solution-assisted snare technique. Postoperative bleeding was seen in 1 of 32 patients (3.1%) who underwent the endoscopic cap band mucosectomy technique.


CONCLUSIONS
In GSLs smaller than 20 mm, ESMR with saline solution-assisted snare or endoscopic cap band mucosectomy techniques is safe, the adverse event rate is low, accurate diagnosis is achieved, and treatment with en bloc resection is provided in a single session. Given similar success and adverse event rates, saline solution-assisted ESMR may be the preferred technique because of its lower cost advantages.
Division of Gastroenterology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Cetin
C
Karaca
Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Ebubekir S
ES
Daglilar
Division of Gastroenterology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Ozlem Mutluay
OM
Soyer
Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Mine
M
Gulluoglu
Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
William R
WR
Brugge
D000328:Adult; D000368:Aged; D002828:Choristoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D007889:Leiomyoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008221:Lymphoid Tissue / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D010179:Pancreas; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D047368:Tumor Burden