Surgical Endoscopy

, Volume 32, Issue 5, pp 2575–2582 | Cite as

The fourth space surgery: endoscopic subserosal dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria layer

  • Fei Liu
  • Song Zhang
  • Wei Ren
  • Tian Yang
  • Ying Lv
  • Tingsheng Ling
  • Xiaoping Zou
  • Lei Wang
New Technology

Abstract

Background and aims

We developed a novel method of endoscopic subserosal dissection (ESSD) for removal of subepithelial tumors (SETs) originating from the muscularis propria (MP) layer in the upper gastrointestinal (GI) tract. The aim of this study was to evaluate the efficacy, safety, and clinical outcome of this method.

Methods

Eleven patients with upper GI SETs originating from the MP layer were treated by ESSD between October 2016 and March 2017. ESSD technique consists of six major procedures: (1) incising the mucosal and submucosal layer around the lesion and exposing MP layer; (2) continuous injection was performed while the injection needle slowly moved from the MP layer toward the subserosal layer; (3) incising MP layer; (4) subserosal injection was performed to further separate the serosa from the MP layer; (5) the mucosa, submucosa, and MP layer including SET were carefully dissected en bloc; and (6) closure of the gastric-wall defect with endoscopic techniques. Primary outcome including clinical procedural success and procedure-related adverse events were documented.

Results

ESSD was successfully performed in 11 patients. The complete resection rate was 100%, and the mean operation time was 51 (range 22–76) min. The mean resected lesion size was 27 (range 15–40) mm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (8/11), heterotopic pancreas (1/11), hamartoma (1/11), and leiomyoma (1/11). The small perforations occurred in two patients (4 × 4 and 5 × 5 mm, respectively) during the operation. All perforations and defects were closed successfully by endoscopic techniques. No GI bleeding, peritonitis, abdominal abscess, and other adverse events were observed. No lesion residual or recurrence was found during the follow-up period (mean 18 weeks; range 10–29 weeks).

Conclusion

ESSD seems to be an efficacious, safe, and minimally invasive treatment for patients with upper GI SETs originating from the MP layer, making it possible to resect deep lesions, provide precise pathological diagnosis, and maintain the integrity of serosa.

Keywords

Endoscopic resection Endoscopic subserosal dissection (ESSD) Subepithelial tumors (SETs) Gastrointestinal stromal tumors (GISTs) 

Notes

Compliance with ethical standards

Disclosures

Drs. Fei Liu, Song Zhang, Wei Ren, Tian Yang, Ying Lv, Tingsheng Ling, Xiaoping Zou, and Lei Wang have no conflicts of interests or financial ties to disclose.

Supplementary material

464_2017_5985_MOESM1_ESM.wmv (84.7 mb)
Supplementary material 1 (WMV 86740 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of GastroenterologyThe Affiliated Drum Tower Hospital of Nanjing University, Medical SchoolNanjingChina
  2. 2.Department of GeriatricsThe Affiliated Drum Tower Hospital of Nanjing University, Medical SchoolNanjingChina

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