Abstract:

Objective To evaluate the efficacy and safety of endoscopic

resection for submucosal tumors（SMT） of upper gastrointestinal tract and to

analyze histological type of SMT. Methods Of 426 SMTs， 346 located in esophagus， 79 in stomach， 1 in duodenum. By endoscopic ultrasonography（EUS）， 284 lesions were in muscularis mucosa，87 in submucosal layer， 55 in muscularis propia. Lesions ranged from 0.4cm to 6cm（0.90±0.03cm）. Three hundred and thirtythree patients were managed by endoscopic mucosal resection（EMR）， 37 by endoscopic submucosal dissection（ESD）， 47 by endoscopic submucosal excavation（ESE）， and 9 by endoscopic fullthickness resection（EFR）. Results In EMR group， 314 out of 333 lesions（94.3％） were en bloc resected， compared with 100.0％ in ESD group and EFR group，and 44 out of 47 lesions（93.6％） in ESE group. Three cases（2 complicated with unmanaged perforation，1 with maximum diameter reaching 6cm） from ESE group performed surgery for unsuccessful endoscopic resection. 1 case from ESD and ESE group each with delayed hemorrhage had endoscopic hemostatic therapy without surgery. Nine active perforation in EFR group were all successfully managed by endoscopy. Three hundred and twenty-six lesions were histopathologically diagnosed as leiomyoma， 58 as gastrointestinal stromal tumors. No case relapsed in 2 years followed-up. Conclusion Endoscopic resection can be a safe and effective treatment for upper gastrointestinal tract SMT.