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• W3033990783 abstract "Upper gastrointestinal submucosal tumours (U-SMTs) are infrequent but may contain malignant potential. Some may require removal for treatment and on occasion definitive diagnosis may necessitate complete U-SMT excision. A range of techniques have been developed to facilitate endoscopic removal and avoid surgical resection, even for lesions involving the muscularis propria (MP). This includes endoscopic submucosal dissection (ESD), submucosal tunnelling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR). We conducted a prospective observational study over 84 months until October 2019 (NCT 02306707). Procedure technique was guided by pre-resection endoscopic appearance, cross-sectional imaging and predicted MP involvement based on endoscopic ultrasound (EUS). For each lesion, all resection techniques were available. Large oesophageal lesions were planned for STER and gastric lesions for ESD or EFTR with endoscopic suture closure. Lesions >30mm were consented for possible laparoscopic gastrotomy for specimen retrieval by the surgical team. 59 endoscopic resections for U-SMTs were performed (mean age 61 ± 12, 57.6% male). Procedures included ESD (n=47, 79.7%), STER (n=7, 11.9%) and EFTR (n=5, 8.5%; Table 1). Mean lesion size was 22±14 mm. Pathology included leiomyoma (29.3%), neuroendocrine tumours (27.6%), GISTs (12.1%) and granular cell tumours (10.3%). 45 (76.3%) patients were admitted for observation, with median length of stay of 1 day (IQR 1-2). There were no adverse events. Technical success for ESD was 87.2%. En bloc resection was achieved in 97.6%. Involvement of the MP was identified in 7 (14.9%) cases and did not correlate with tissue layer on EUS (p=0.83). Six lesions were deemed non-resectable intra-procedurally and were referred to surgery, with five located in the stomach (p=0.15). Two lesions resected by EFTR, of 40mm & 50mm size, required laparoscopic gastrotomy for retrieval. U-SMTs can be effectively treated with endoscopic resection techniques. As the extent of MP involvement may not be reliably appreciated by EUS or cross-sectional imaging, a switch between endoscopic resection approaches should be considered intra-procedurally if required. Planned resection for lesions >30mm should involve a surgical team for consideration of laparoscopic gastrotomy to retrieve the specimen, as this still allows for organ preservation." @default.
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• W3033990783 date "2020-06-01" @default.
• W3033990783 modified "2023-10-16" @default.
• W3033990783 title "Sa2020 ENDOSCOPIC RESECTION OF UPPER GASTROINTESTINAL SUBMUCOSAL TUMOURS: ESD, STER AND EFTR" @default.
• W3033990783 doi "https://doi.org/10.1016/j.gie.2020.03.1795" @default.
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