A clinical study of modified endoscopic submucosal excavation for the treatment of small gastric submucosal tumors

doi:10.3877/cma.j.issn.2095-7157.2024.02.004

Abstract

Abstract:

Objective

Endoscopic submucosal excavation (ESE) is a widely accepted method for the resection of submucosal tumors (SMT).This study evaluated the clinical effecacy and feasibility of modified ESE in the treatment of small gastric submucosal tumors, namely Ctype endoscopic submucosal excacation(CESE).

Methods

The retrospective analysis was performed on data of 87 patients who underwent ESE for small gastric submucosal tumors (longest diameter≤2 cm) at the Department of Endoscopy in Tianjin Medical University General Hospital from January 2016 to August 2020.Patients were divided into the CESE group (n=40) and the conventional ESE group (n=47). Eendoscopic operation time, operation speed, time and number of submucosal injections, en bloc resection rate, R0 resection rate, rate of intraoperative EUS and postoperative complications of the two groups were compared.

Results

There was no statistically significant differences in basic information between the two groups (P>0.05). Endoscopic operation time was 22.2±5.8 min in the CESE group and 35.4±10.1 min in the conventional ESE group with statistically significant difference (P<0.001). Endoscopic operation speed in the CESE group was 9.1±6.6 mm²/min, which was faster than 4.7±4.7 mm²/min in the conventional ESE group (P<0.001). The number of submucosal injections in the CESE group was less than that in the conventional ESD group [1 (1, 1) vs 3 (3, 4), P< 0.001].In the conventional ESE group, 7 patients received intraoperative EUS, while no intraoperative EUS occurred in the CESE group (P=0.014). There was no significant differences in en bloc resection rate, R0 resection rate and postoperative complications between the two groups (P>0.05).All patients were followed up for more than 1 year. None of the patients required additional surgical treatment, and no complications or recurrence occurred during the follow-up period.

Conclusion

C-ESE is a feasible and reliable treatment strategy for small gastric SMT (tumor longest diameter≤2 cm), which can shorten the endoscopic operation time, reduce the difficulty of lesion exposure and avoid the assistance of intraoperative EUS.

Key words: Submucosal tumors, Endoscopic submucosal excavation, Ctype incision

Shuangzhe Yao, Yang Jing, Bangmao Wang, Wentian Liu, Zhongqing Zheng. A clinical study of modified endoscopic submucosal excavation for the treatment of small gastric submucosal tumors[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2024, 11(02): 88-93.

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References 31

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项目	全部(n＝87)	C-ESE组(n＝40)	传统ESE组(n＝47)	P值
患者特征
年龄(岁)	53.1±10.8	54.4±12.4	52.0±9.2	0.308
性别				0.154
男	42(48.3)	16(40)	26(55.3)
女	45(51.7)	24(60)	21(44.7)
病变特征
位置				0.653
胃底	37(42.5)	15(37.5)	22(46.8)
胃体	31(35.6)	16(40)	15(31.9)
胃窦	19(21.8)	9(22.5)	10(21.3)
长径(mm)	12.2±5.2	12.8±4.3	11.66±5.8	0.320
组织学				0.610
间质瘤	31(35.6)	14(35)	17(36.2)
平滑肌瘤	34(39.1)	18(45)	16(34)
脂肪瘤	7(8.0)	3(7.5)	4(8.5)
异位胰腺	13(14.9)	5(12.5)	8(17)
神经鞘瘤	2(2.3)	0(0)	2(4.3)
病变深度				0.661
黏膜下层	22(25.3)	11(27.5)	11(23.4)
固有肌层	65(74.7)	29(72.5)	36(76.6)

项目	全部(n＝87)	C-ESE组(n＝40)	传统ESE组(n＝47)	P值
患者特征
年龄(岁)	53.1±10.8	54.4±12.4	52.0±9.2	0.308
性别				0.154
男	42(48.3)	16(40)	26(55.3)
女	45(51.7)	24(60)	21(44.7)
病变特征
位置				0.653
胃底	37(42.5)	15(37.5)	22(46.8)
胃体	31(35.6)	16(40)	15(31.9)
胃窦	19(21.8)	9(22.5)	10(21.3)
长径(mm)	12.2±5.2	12.8±4.3	11.66±5.8	0.320
组织学				0.610
间质瘤	31(35.6)	14(35)	17(36.2)
平滑肌瘤	34(39.1)	18(45)	16(34)
脂肪瘤	7(8.0)	3(7.5)	4(8.5)
异位胰腺	13(14.9)	5(12.5)	8(17)
神经鞘瘤	2(2.3)	0(0)	2(4.3)
病变深度				0.661
黏膜下层	22(25.3)	11(27.5)	11(23.4)
固有肌层	65(74.7)	29(72.5)	36(76.6)

项目	全部(n＝87)	C-ESE组(n＝40)	传统ESE组(n＝47)	P值
手术时间(min，±s)	29.4±10.7	22.2±5.8	35.4±10.1	0.000
黏膜下注射时间(s，±s)	28.1±18.6	9.6±2.1	43.8±9.7	0.000
黏膜下注射次数[次，M(Q₁，Q₃)]	3(1，3)	1(1，1)	3(3，4)	0.000
剥离时间(min，±s)	18.0±8.9	12.3±4.4	22.9±8.8	0.000
手术速度(mm²/min，±s)	6.8±6.0	9.1±6.6	4.7±4.7	0.001
术中EUS使用[n(%)]	7(8)	0(0)	7(14.9)	0.014

项目	全部(n＝87)	C-ESE组(n＝40)	传统ESE组(n＝47)	P值
手术时间(min，±s)	29.4±10.7	22.2±5.8	35.4±10.1	0.000
黏膜下注射时间(s，±s)	28.1±18.6	9.6±2.1	43.8±9.7	0.000
黏膜下注射次数[次，M(Q₁，Q₃)]	3(1，3)	1(1，1)	3(3，4)	0.000
剥离时间(min，±s)	18.0±8.9	12.3±4.4	22.9±8.8	0.000
手术速度(mm²/min，±s)	6.8±6.0	9.1±6.6	4.7±4.7	0.001
术中EUS使用[n(%)]	7(8)	0(0)	7(14.9)	0.014

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