Exploring endoscopic treatment strategies and efficacy analysis based on the growth pattern of gastric submucosal tumors

doi:10.3877/cma.j.issn.2095-7157.2025.02.006

Abstract

Abstract:

Objective

This article aims to explore the selection and efficacy of endoscopic treatment strategies based on gastric SMT growth pattern.

Methods

A retrospective collection was conducted on 143 patients with gastric SMT who were hospitalized at the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Chinese Medicine from January 2014 to August 2024. Their growth patterns were determined based on endoscopic ultrasound (EUS) or CT scans,and the selection of endoscopic treatment strategies,effects,and complications were analyzed.

Results

Among 143 patients, 63 were in the endoluminal group,50 in the intramural group and 30 in the extraluminal group; There were 58 males and 85 females with an average age of (57.84 ±11.99) years. There was no significant difference in age, sex, growth site, tumor diameter, operation time, endoscopic complete resection rate and pathological type among the three groups(P>0.05). The EFR rate, purse string suture rate and gastric tube indwelling rate in the extraluminal group and intramural group were significantly higher than those in the luminal group (P< 0.001,0.002, <0.001). Further multivariate regression analysis showed that only the surgical methods between these groups were still statistically different (P=0.011), but the wound suture method and gastric tube indwelling rate were not statistically significant (P=0.159,0.131). Subgroup analysis showed that the EFR rate of lesions located in the fundus of stomach was significantly higher than that of non-fundus of stomach (P =0.049,0.021). Further multivariate analysis showed that the EFR rate of lesions located in the fundus of stomach was significantly higher than that of non-fundus of stomach in the intramural group only (P =0. 003).

Conclusion

Endoscopic treatment of gastric SMT is safe and effective. ESE treatment is mainly used for intracavitary and intramural SMT in non gastric fundus areas, while EFR treatment is required for intramural SMT in gastric fundus areas and all extraluminal SMT. The growth pattern of gastric SMT has guiding significance for the selection of endoscopic treatment strategies, which is helpful for preoperative preparation and perioperative management.

Key words: Submucosal tumors, Endoscopic submucosal excavation, Endoscopic full-thickness resection, Growth pattern

Youzhu Lu, Yonggang Ding, Qinmei Fan, Fangyuan Li, Dapeng Wu, Lei Wang, Yuhong Zhou, Qide Zhang. Exploring endoscopic treatment strategies and efficacy analysis based on the growth pattern of gastric submucosal tumors[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(02): 96-102.

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References 30

[1]	Sharzehi K,Sethi A,Savides T.AGA Clinical Practice Update on Management of Subepithelial Lesions Encountered During Routine Endoscopy:Expert Review[J].Clin Gastroenterol Hepatol,2022,20(11):2435-2443,e4.
[2]	彭金榜,叶丽萍,毛鑫礼,等.上消化道黏膜下肿瘤1237 例次的病理学特征和分布特点[J].中华消化杂志,2019,39(2):94-99.
[3]	Deprez PH, Moons LMG, O′ Toole D, et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy(ESGE) Guideline[J].Endoscopy,2022,54(4):412-429.
[4]	周平红,李兆申,秦新裕.中国消化道黏膜下肿瘤内镜诊治专家共识(2023 版)[J].中华消化内镜杂志,2023,40(4):253-263.
[5]	徐佳昕,时强,周平红.内镜下全层切除术治疗胃黏膜下肿瘤的技术进展[J].中华消化内镜杂志,2015,32(1):63-65.
[6]	Kaan HL, Ho KY. Endoscopic Full Thickness Resection for Gastrointestinal Tumors-Challenges and Solutions [ J]. Clin Endosc,2020,53(5):541-549.
[7]	徐兆军,张予蜀,张振玉.内镜黏膜下剥离术及全层切除术治疗胃黏膜下肿瘤的临床效果分析[J]. 中国肿瘤临床,2021,48(14):728-732.
[8]	McCarty TR,Ryou M. Endoscopic diagnosis and management of gastric subepithelial lesions[J]. Curr Opin Gastroenterol,2020,36(6):530-537.
[9]	Wu J,Mao B,Jin T,et al. Comparative Study on the Clinical Effects of Different Surgical Methods in the Treatment of Gastrointestinal Stromal Tumors[J]. Evid Based Complement Alternat Med,2022,2022:1280756.
[10]	Ji YK,Jeong ML,Kyung WK,et al.Ectopic pancreas:CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma[J].Radiology,2009,252(1):92-100.
[11]	Joensuu H,Hohenberger P,Corless CL. Gastrointestinal stromal tumour[J].Lancet,2013,382(9896):973-983.
[12]	Corless CL,Barnett CM,Heinrich MC. Gastrointestinal stromal tumours: origin and molecular oncology[J]. Nat Rev Cancer,2011,11(12):865-878.
[13]	Gao Z,Wang C,Xue Q,et al.The cut-off value of tumor size and appropriate timing of follow-up for management of minimal EUS-suspected gastric gastrointestinal stromal tumors [ J]. BMC Gastroenterol,2017,17:8.
[14]	Kim SY,Shim KN,Lee JH,et al. Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors[J].Clin Endosc,2019,52(6):565-573.
[15]	Ko WJ,Cho JY. Current Techniques for Treating Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract[J]. Clin Endosc,2016,49(3):226-228.
[16]	Bialek A, Wiechowska-Kozlowska A, Pertkiewicz J, et al.Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video) [J]. Gastrointest Endosc,2012,75(2):276-286.
[17]	Chun SY,Kim KO,Park DS,et al.Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: a preliminary analysis of appropriate indications[J].Surg Endosc,2013,27(9):3271-3279.
[18]	He Z,Sun C,Wang J,et al. Efficacy and safety of endoscopic submucosal dissection in treating gastric subepithelial tumors originating in the muscularis propria layer:a single-center study of 144 cases[J]. Scand J Gastroenterol,2013,48(12):1466-1473.
[19]	Hwang JC,Kim JH,Kim JH,et al. Endoscopic resection for the treatment of gastric subepithelial tumors originated from the muscularis propria layer[J]. Hepatogastroenterology,2009,56(94-95):1281-1286.
[20]	Zhou PH,Yao LQ,Qin XY,et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria[J]. Surg Endosc,2011,25(9):2926-2931.
[21]	Huang LY, Cui J, Wu CR, et al. Endoscopic full-thickness resection and laparoscopic surgery for treatment of gastric stromal tumors[J].World J Gastroenterol,2014,20(25):8253-8259.
[22]	Zhu Y,Xu MD,Xu C,et al. Microscopic positive tumor margin does not increase the rate of recurrence in endoscopic resected gastric mesenchymal tumors compared to negative tumor margin[J].Surg Endosc,2020,34(1):159-169.
[23]	Demetri GD,von Mehren M,Antonescu CR,et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors[J]. J Natl Compr Canc Netw,2010,8(Suppl 2):S1-41; quiz S2-4.
[24]	McCarter MD,Antonescu CR,Ballman KV,et al. Microscopically positive margins for primary gastrointestinal stromal tumors:analysis of risk factors and tumor recurrence[J].J Am Coll Surg,2012,215(1):53-59; discussion 9-60.
[25]	Casali PG,Blay JY,Abecassis N,et al. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up [ J]. Ann Oncol,2022,33(1):20-33.
[26]	Holmebakk T,Bjerkehagen B, Boye K,et al. Definition and clinical significance of tumour rupture in gastrointestinal stromal tumours of the small intestine[J].Br J Surg,2016,103(6):684-691.
[27]	Boye K,Berner JM,Hompland I,et al. Genotype and risk of tumour rupture in gastrointestinal stromal tumour[J]. Br J Surg,2018,105(2):e169-e175.
[28]	Holmebakk T,Hompland I,Bjerkehagen B,et al. Recurrence-Free Survival After Resection of Gastric Gastrointestinal Stromal Tumors Classified According to a Strict Definition of Tumor Rupture:A Population-Based Study[J]. Ann Surg Oncol,2018,25(5):1133-1139.
[29]	Qiao WG,Ren YT,Gong W,et al.Cap-aspiration lumpectomy for small submucosal tumors originating from the muscularis propria of the gastric fundus:a preliminary study (with videos) [J]. J Dig Dis,2015,16(11):642-648.
[30]	Li L,Wang F,Wu B,et al. Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria[J]. Exp Ther Med,2013,6(2):391-395.

项目	患者总数（n = 143）
年龄[岁,（x̄ ± s）]	57.84 ± 11.99
性别
男	58
女	85
生长方式
腔内型	50
壁内型	63
腔外型	30
部位
胃底	75
胃体	60
胃角	3
胃窦	5
瘤体直径[cm,（x̄ ± s）]	2.47 ± 1.01
手术方式
ESE	56
EFR	87
手术时间[min,（x̄ ± s）]	34.37 ± 18.21
创面闭合方式
钛夹夹闭	98
荷包缝合	45
留置胃管
是	85
否	58
内镜完整切除
是	138
否	5
病理类型
间质瘤	98
平滑肌瘤	37
神经鞘瘤	4
钙化性纤维瘤	4

项目	患者总数（n = 143）
年龄[岁,（x̄ ± s）]	57.84 ± 11.99
性别
男	58
女	85
生长方式
腔内型	50
壁内型	63
腔外型	30
部位
胃底	75
胃体	60
胃角	3
胃窦	5
瘤体直径[cm,（x̄ ± s）]	2.47 ± 1.01
手术方式
ESE	56
EFR	87
手术时间[min,（x̄ ± s）]	34.37 ± 18.21
创面闭合方式
钛夹夹闭	98
荷包缝合	45
留置胃管
是	85
否	58
内镜完整切除
是	138
否	5
病理类型
间质瘤	98
平滑肌瘤	37
神经鞘瘤	4
钙化性纤维瘤	4

项目	腔内型（n = 63）	壁内型（n = 50）	腔外型（n = 30）	P 值	P' 值
年龄（岁）	57.83	56.92	59.4	0.65
性别			0.66
男	27	21	10
女	36	29	20
部位				0.25
胃底	36	25	13
胃体	26	22	13
胃角	0	2	1
胃窦	1	1	3
瘤体直径[cm,（x̄ ± s）]	2.53 ± 0.92	2.43 ± 1.10	2.40 ± 1.05	0.30
手术方式				<0.001	0.011
ESE	38	17	0
EFR	25	33	30
手术时间[min,（x̄ ± s）]	31.29 ± 15.16	33.24 ± 16.45	42.73 ± 24.09	0.15
创面闭合方式				0.002	0.159
钛夹夹闭	52	31	15
荷包缝合	11	19	15
留置胃管				<0.001	0.131
是	28	31	26
否	35	19	4
内镜完整切除				0.971
是	61	48	29
否	2	2	1
病理类型				0.079
间质瘤	42	29	26
平滑肌瘤	20	16	1
神经鞘瘤	1	2	1
钙化性纤维瘤	0	3	2

项目	腔内型（n = 63）	壁内型（n = 50）	腔外型（n = 30）	P 值	P' 值
年龄（岁）	57.83	56.92	59.4	0.65
性别			0.66
男	27	21	10
女	36	29	20
部位				0.25
胃底	36	25	13
胃体	26	22	13
胃角	0	2	1
胃窦	1	1	3
瘤体直径[cm,（x̄ ± s）]	2.53 ± 0.92	2.43 ± 1.10	2.40 ± 1.05	0.30
手术方式				<0.001	0.011
ESE	38	17	0
EFR	25	33	30
手术时间[min,（x̄ ± s）]	31.29 ± 15.16	33.24 ± 16.45	42.73 ± 24.09	0.15
创面闭合方式				0.002	0.159
钛夹夹闭	52	31	15
荷包缝合	11	19	15
留置胃管				<0.001	0.131
是	28	31	26
否	35	19	4
内镜完整切除				0.971
是	61	48	29
否	2	2	1
病理类型				0.079
间质瘤	42	29	26
平滑肌瘤	20	16	1
神经鞘瘤	1	2	1
钙化性纤维瘤	0	3	2

项目	腔内型		P 值	P' 值	壁内型		P 值	P' 值
项目	ESE	EFR	P 值	P' 值	ESE	EFR	P 值	P' 值
年龄[岁,（x̄ ± s）]	56.92 ± 14.02	59.2 ± 10.12	0.48		54.65 ± 14.62	58.09 ± 11.51	0.36
性别			0.026	0.048			0.2
男	12	15			5	16
女	26	10			12	17
部位			0.049	0.062			0.021	0.003
胃底	18	18			4	21
胃体	19	7			11	11
胃角	0	0			2	0
胃窦	1	0			0	1
瘤体直径[cm,（x̄ ± s）]	2.5 ± 0.98	2.58 ± 0.85	0.75		2.42 ± 0.93	2.43 ± 1.19	0.83
手术时间[min,（x̄ ± s）]	27.66 ± 12.91	36.8 ± 16.86	0.08		28.88 ± 14.45	35.48 ± 17.17	0.18
创面闭合方式			<0.001	0.067			<0.001	0.008
钛夹夹闭	37	15			16	15
荷包缝合	1	10			1	18
留置胃管			0.011	0.011			0.005	<0.001
是	12	16			6	25
否	26	9			11	8
内镜完整切除			0.77			0.63
是	37	24			16	32
否	1	1			1	1
病理类型			<0.001	0.001			0.042	0.036
间质瘤	19	23			5	25
平滑肌瘤	18	2			11	5
神经鞘瘤	1	0			0	2
钙化性纤维瘤	0	0			1	1

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