Endoscopic aspiration mucosectomy as curative endoscopic surgery; analysis of 24 cases of early gastric cancer

Hydroxypropyl methylcellulose: A better submucosal fluid cushion for endoscopic mucosal resection

BACKGROUND

Formation of a submucosal fluid cushion has become integral to endoscopic mucosal and polyp resection. Solutions available for injection into the submucosa of the GI tract create short-lasting submucosal fluid cushions or are costly. The feasibility, durability, and histologic response to submucosal fluid cushions created by injection of hydroxypropyl methylcellulose were studied in the esophagus of pigs.

METHODS

Thirty-six esophageal submucosal fluid cushions created with hydroxypropyl methylcellulose were studied in 12 animals divided in 2 groups of 6 animals each. In Group I, 18 submucosal fluid cushions were created by submucosal injection of hydroxypropyl methylcellulose followed by tattooing. In Group II, 18 submucosal fluid cushions were created by submucosal injection of hydroxypropyl methylcellulose, with sites marked by an endoscopically placed suture. In all cases, the duration of the submucosal fluid cushion was measured. After 7 days, submucosal fluid cushion sites were assessed by EGD, necropsy, and histologic evaluation.

RESULTS

The mean submucosal fluid cushion duration was 36 minutes (3-45 minutes) and 38 minutes (5-45 minutes) for, respectively, Groups I and II. EGD and necropsy after 1 week showed normal-appearing mucosa at the site of all submucosal fluid cushions in both groups. Some Group I animals additionally had nodules at the tattoo sites. Histologic assessment demonstrated minimal alterations in 33 of 36 (92%) submucosal fluid cushion sites and localized mild inflammatory reaction in 3 of 36 (8%). In Group I, 8 of 18 (44%) tattoo sites exhibited a significant inflammatory reaction, including 3 abscesses.

CONCLUSIONS

Hydroxypropyl methylcellulose creates a long-lasting submucosal fluid cushion with minimal tissue reaction and should be considered a low-cost option for creating submucosal fluid cushions. The use of tattooing with carbon black should be carefully considered when histologic study is required to assess potential inflammatory tissue responses to an invasive technique or instillation of foreign material in the GI tract.

Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer

BACKGROUND

Endoscopic mucosal resection is an established treatment option for early stage gastric cancer. However, several problems with endoscopic mucosal resection remain to be solved, such as appropriate treatment for recurrence and incomplete tumor resection. The outcome for patients undergoing endoscopic aspiration mucosectomy (endoscopic mucosal resection) by a modification of the cap-fitted technique was evaluated retrospectively to determine factors associated with complete resection and tumor recurrence.

METHODS

Endoscopic mucosal resection was performed in 106 patients with early stage gastric cancers up to 20 mm in diameter that were well or moderately differentiated adenocarcinoma. All were superficial lesions without ulceration, distinct signs of submucosal invasion, or a poorly demarcated border. En bloc (tumors <10 mm in diameter) or piecemeal (tumors 10-20 mm in diameter) resection was performed. Follow-up endoscopy was performed at 2, 6, 12, 18, and 24 months and thereafter once per year. Outcome and factors associated with complete resection and tumor recurrence were assessed retrospectively.

RESULTS

Sixty-eight patients (64%) underwent en bloc resection and 38 (36%) piecemeal resection. The mean longest dimension (SD) of the resected lesions was significantly greater after piecemeal resection (12.3 [4.0] mm) than after en bloc resection (7.6 [4.0] mm; p < 0.01). In patients with tumors completely resected, there was no recurrence after either en bloc or piecemeal resection. Six of 8 patients found to have submucosal invasion after endoscopic mucosal resection underwent surgery. Patients with incompletely resected intramucosal lesions underwent additional endoscopic treatment. Cancer recurred in 3 patients (2.8%), all of whom had lesions measuring more than 15 mm in diameter.

CONCLUSIONS

Endoscopic mucosal resection is safe and useful for the management of early stage gastric cancer. Further improvement in outcome requires more accurate preoperative diagnosis and postoperative histopathologic evaluation. Patients with incompletely resected lesions should undergo aggressive additional treatment.

Comparative performance in the porcine esophagus of different solutions used for submucosal injection

BACKGROUND

Before endoscopic mucosal resection and polypectomy of sessile lesions, injection of fluid into the submucosa cushions and isolates the tissue and thereby reduces thermal injury and the risk for perforation and hemorrhage. This study investigated the performance of 5 different solutions when used to form submucosal fluid cushions in the porcine esophagus.

METHODS

Five groups of 5 pigs were studied. In each pig, 6 separate submucosal injections of 5 mL of a single test solution were performed within the distal third of the esophagus. The time required for the submucosal bleb to flatten completely was recorded after each injection. The solutions used were as follows: normal saline solution, normal saline plus epinephrine solution, 50% dextrose, 10% glycerine/5% fructose in normal saline solution, and 1% rooster comb hyaluronic acid.

RESULTS

The normal saline solution and normal saline plus epinephrine solutions had the shortest disappearance times (respectively, median 2.4 and 3.0 minutes), which were significantly shorter compared with the other test solutions. The mean disappearance times for 50% dextrose and 10% glycerine were, respectively, 4.7 and 4.2 minutes. The mean disappearance time for hyaluronic acid was 22.1 minutes.

CONCLUSIONS

A solution of hyaluronic acid appears to be ideal for producing a lasting submucosal cushion for prolonged procedures. Dextrose 50% is superior to normal saline solution and may serve as an alternative to hyaluronic acid in terms of availability and cost.

Circumferential endoscopic mucosal resection in the swine esophagus assisted by a cap attachment

BACKGROUND

The feasibility and safety of piecemeal, circumferential endoscopic mucosal resection of the distal esophagus are unknown. This study assessed this procedure in a porcine model.

METHODS

Different techniques of endoscopic mucosal resection were tested in Phase I of the study in two animals. During Phase II, 6 pigs underwent piecemeal cap-assisted EMR of the distal esophagus. The mucosa of one half of the circumference of the distal 5 cm of the esophagus was resected. After complete endoscopic re-epithelization, endoscopic mucosal resection was performed on the remaining unresected hemi-circumference. Healing was promoted by daily administration of lansoprazole and documented by weekly endoscopy.

OBSERVATIONS

In Phase I, one perforation occurred during initial testing of cap-assisted endoscopic mucosal resection. Subsequent cap-assisted endoscopic mucosal resection led to homogenous and uniform piecemeal resection of mucosa. In Phase II, circumferential cap-assisted endoscopic mucosal resection was performed in 6 pigs without perforation or major bleeding. Complete endoscopic re-epithelization occurred over a mean of 3.6 weeks (range: 3-5). Strictures developed in 3 animals.

CONCLUSIONS

Piecemeal circumferential cap-assisted endoscopic mucosal resection is safe and feasible in the normal swine esophagus. Proper technique for cap-assisted piecemeal endoscopic mucosal resection is necessary to minimize the risk of perforation. Procedural complications include esophageal stricture formation.

A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms

BACKGROUND

En bloc resection is optimal for the cure of gastric neoplasms by endoscopic mucosal resection (EMR). A new technique was developed for EMR by using an insulated-tip electrosurgical knife (IT-EMR). This is a report on the clinical application of IT-EMR.

METHODS

IT-EMR of 123 gastric tumors was performed in 120 patients. The en bloc resection rate, completeness of resection, and associated complications were evaluated. The local recurrence rate was studied for 90 intramucosal lesions followed for more than 6 months without further treatment.

RESULTS

The en bloc resection rate for all lesions was 54% (67/123 lesions). The en bloc resection rates were 82% (27/33) for lesions 10 mm or less in size, 54% (29/54) for those between 11 mm and 20 mm, and 31% (11/36) for those of over 20 mm. Complete resection rates in the cases with en bloc resection were 78% (21/27) for lesions 10 mm or less in size, 76% (22/29) for those between 11 mm and 20 mm, and 73% (8/11) for those over 20 mm. There were no episodes of major bleeding that required blood transfusion or surgical intervention; minor bleeding including oozing occurred in 38% (47/123). Perforation occurred in 1 case (1/123; 0.8%). The local recurrence rate for lesions resected en bloc was significantly lower than that for lesions resected as multiple fragments (respectively, 2/49; 4.1% vs. 7/41; 17%: p = 0.041).

CONCLUSIONS

IT-EMR is feasible in clinical practice and has a high en bloc resection rate. En bloc resection may reduce the rate of local recurrence.

Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases

BACKGROUND

Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial neoplastic lesions of the GI tract. The aim of this study was to assess the safety, efficacy, and clinical outcomes of EMR.

METHODS

Data from consecutive EMR procedures performed by using suction cap-assisted and/or saline solution-assisted snare resection techniques over a 45-month period were reviewed retrospectively. EUS was performed before EMR in the majority of cases. Immediate and delayed complications were recorded. Survival was assessed in patients with carcinoma or high-grade dysplasia on final histopathology in whom EMR achieved complete resection.

RESULTS

One hundred one lesions were removed by EMR in 92 patients. Indications were adenoma (67%), high-grade dysplasia (13%), intramucosal carcinoma (11%), and lesions of uncertain histopathology (10%). Locations were esophagus 19%, stomach 14%, duodenum 27%, rectum 12%, and colon 29%. Suction cap-assisted technique was used in 26% and saline solution-assisted polypectomy in 74% of cases. Complete resection was achieved in 89%. For complete resection, 17% required more than 1 session. Post-EMR histopathology was adenoma 47%, high-grade dysplasia 13%, carcinoma 16%, carcinoid 3%, benign 19%, and low-grade dysplasia 3%. EMR resulted in upgrading of histopathologic staging to carcinoma or high-grade dysplasia in 44%. Bleeding was the only complication (early 16, delayed 6). The median cancer-free survival in patients with adenocarcinoma who underwent complete resection by EMR was 27 months (interquartile range: 17-28 months).

CONCLUSION

EMR achieves complete resection in a majority of patients but is associated with a higher risk of bleeding compared with standard polypectomy. EMR changes pathologic stage in a significant number of patients. Survival data are encouraging, but long-term follow-up studies are needed.

Review article: the potential role for photodynamic therapy in the management of upper gastrointestinal disease

Photodynamic therapy involves the activation of an exogenously administered, or an endogenously generated, photosensitizer with light to produce localized tissue destruction. It is an attractive, predominantly endoscopic technique for the palliation of advanced upper gastrointestinal cancer and the eradication of early neoplastic and pre-neoplastic lesions. The nature of the biological response allowing safe healing and the exploitation of tissue threshold effects mean that adjacent tissue damage can be minimized. This review used a database of 368 papers. The nature of the photosensitizer is critical to the depth of tissue damage and the risk of adjacent tissue damage and stricture formation. The generation of protoporphyrin IX following administration of 5-aminolaevulinic acid has proved useful for the treatment of high-grade dysplasia in Barrett's oesophagus. A double-blind randomized placebo controlled trial has confirmed that it is a safe and effective method for the ablation of low-grade dysplasia. The treatment of more advanced lesions requires exogenously administered photo-sensitizers. However, recent data indicate that the neoplastic potential remains in some patients and continued follow-up is necessary. Photodynamic therapy can be used to eradicate early neoplasia and palliate advanced cancer, but caution is required before a definitive cure can be claimed.

Clinical outcome of endoscopic mucosal resection for superficial GI lesions and the role of high-frequency US probe sonography in an American population

BACKGROUND

Endoscopic mucosal resection, a major advance in endoscopy, provides an endoscopic option for management of focal and superficial lesions of the gastrointestinal tract. Although popular in the Orient due to the high incidence of superficial neoplasia, there are scant data on its use in the United States. Our aim was to assess the efficacy and safety of endoscopic mucosal resection in our patient population and evaluate whether high-frequency ultrasound (US) probe sonography provides useful information relative to the procedure.

METHODS

Endoscopic mucosal resection was performed in 32 of 33 patients referred for endoscopic management of superficial neoplastic or submucosal lesions. High-frequency US probe sonography was performed with a 20 MHz US probe. Endoscopic mucosal resection was performed after submucosal saline solution injection with the strip biopsy technique.

RESULTS

Thirty-two superficial lesions were resected. Of 24 epithelial lesions resected, 22 were intramucosal and 2 had early submucosal invasion (SM1); the 2 patients with the latter 2 lesions were poor candidates for surgery. Depth of penetration of 25 of 26 lesions scanned was accurately predicted by high-frequency US probe sonography. Eight lesions raised from the submucosa. Minor complications were limited to the colon. Of the 7 patients with carcinomas, 6 had no evidence of recurrence at a mean follow-up of 12 months; 1 died of a second primary cancer.

CONCLUSIONS

Endoscopic mucosal resection provided definitive therapy for 24 early-stage neoplastic lesions and provided a diagnosis in the remaining 8. In our study, the technique proved to be safe with only three minor complications noted. High-frequency US probe sonography accurately delineated the depth of penetration of all lesions scanned, therefore making it an ideal imaging modality for selecting patients who may benefit from endoscopic mucosal resection.

Low frequency of bacteremia after endoscopic mucosal resection

BACKGROUND

Endoscopic mucosal resection has become a popular alternative for the treatment of early-stage neoplasia of the gastrointestinal tract. However, there are still no data on the frequency of bacteremia associated with this form of treatment.

METHODS

We conducted a prospective study of 21 men and 17 women undergoing endoscopic mucosal resection with a cap-fitted panendoscope for upper gastrointestinal lesions. Blood cultures were performed before, 10 minutes after, and 4 hours after the procedure for both aerobic and anaerobic bacteria.

RESULTS

Blood culture at baseline was negative in all the patients. Two of 38 patients (5.3 %) had positive blood culture at 10 minutes after the procedure. The isolated microorganisms were Streptococcus salivarius and Corynebacterium species. All patients had negative blood cultures 4 hours later. None of these 38 patients had any symptoms or signs associated with infection.

CONCLUSIONS

Bacteremia associated with endoscopic mucosal resection is infrequent and transient.

Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus

BACKGROUND & AIMS

In view of the mortality and morbidity rates of esophagectomy and the relatively large group of inoperable patients, local therapeutic techniques are required for high-grade dysplasia and early Barrett's cancer.

METHODS

A prospective investigation of endoscopic mucosal resection was conducted in 64 patients (mean age, 65 +/- 10 years) who had early carcinoma (61 patients) or high-grade dysplasia (3 patients) in Barrett's esophagus. Thirty-five patients met the criteria for low risk: macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion; and histological grades G1 and G2 and/or high-grade dysplasia (group A). The remaining 29 patients were included in group B (high risk).

RESULTS

A total of 120 resections were performed, with no technical problems encountered. The mean number of treatment sessions per patient was 1. 3 +/- 0.6 in group A and 2.8 +/- 2.0 in group B (P < 0.0005). Only one major complication occurred, a case of spurting bleeding, which was managed endoscopically. Complete local remission was achieved significantly earlier (P = 0.008) in group A than in group B. In May 1999, complete remission had been achieved in 97% of the patients in group A and in 59% of those in group B; however, 1 patient in group A and 9 in group B are still undergoing treatment or awaiting the first check-up. During a mean follow-up of 12 +/- 8 months, recurrent or metachronous carcinomas were found in 14%.

CONCLUSIONS

Endoscopic mucosal resection of early carcinoma in Barrett's esophagus is associated with promisingly low morbidity and mortality rates. The procedure may offer a new minimally invasive therapeutic alternative to esophagectomy, especially in low-risk situations. Comparisons with surgical results will need to be done when the long-term results of this procedure become available.

Mucosectomy for gastric cancer: current status in Japan

Advances in techniques of image diagnosis have enabled the detection of minute or small cancer lesions in the stomach. Patients with such cancer, in principle, were treated surgically, but accumulated histopathological data on surgical cancer specimens revealed that many of these patients did not have any metastatic lesions. For those localized cancers, local treatment of primary lesions by endoscopy gives curative results. It has been demonstrated that endoscopic therapy is curative in mucosal well-differentiated adenocarcinoma not more than 20 mm in diameter without ulceration. Efforts to cure early gastric cancer without surgery yielded fruitful results and a new treatment concept was established. Even if there is a recurrence of the residual or metachronous lesions, they can be treated by further endoscopic treatment.

Endoscopic mucosal resection using a partial transparent hood for lesions located tangentially to the endoscope

BACKGROUND

Numerous methods have been developed to resect early-stage gastric and esophageal cancers, but it is difficult to resect lesions viewed tangentially with the endoscope.

METHODS

We have designed and developed an original method of endoscopic mucosal resection using a partial transparent hood to treat difficult cases in which the lesions are located tangentially to the endoscope. The hood was attached on the right side of the endoscope and, after insertion into the stomach or the esophagus, was lightly pressed on the orad side of the lesion. Then the lesion was resected using grasping forceps and electrosurgical current snare.

RESULTS

The average diameter of specimens was 26 +/- 8 mm in gastric lesions and 20 +/- 3 mm in esophageal lesions, both 6 mm larger than those obtained by previous methods.

CONCLUSION

This device and technique were extremely useful for mucosal resection of lesions located tangentially to the endoscope.

Usefulness of endoscopic aspiration mucosectomy as compared with strip biopsy for the treatment of gastric mucosal cancer

BACKGROUND

Several techniques are available for the endoscopic treatment of gastric intramucosal cancers, but their advantages and disadvantages have not been adequately evaluated. We compared the therapeutic usefulness of endoscopic aspiration mucosectomy with that of strip biopsy.

METHODS

Between May 1995 and May 1997, we performed strip biopsy (May 1995 through February 1996) or endoscopic aspiration mucosectomy (March 1996 through May 1997) in a consecutive series of patients with intestinal-type intramucosal cancer. Parameters of assessment included the following: size of removed specimens, en bloc resection rate, time required for resection, duration of hospitalization, and complications.

RESULTS

Forty-nine patients with gastric intramucosal cancers underwent endoscopic aspiration mucosectomy and 44 underwent strip biopsy. The two groups were similar with respect to age, gender, and lesion macroscopic appearance, size, and site. The mean longest diameter of the resected specimens was significantly greater with endoscopic aspiration mucosectomy (20.3 +/- 3.4 mm) than with strip biopsy (15. 8 +/- 4.4 mm) (p < 0.001). The rate of en bloc resection (resection of an entire lesion in one procedure) was significantly higher with endoscopic aspiration mucosectomy (61.2%, 30 of 49) than with strip biopsy (36.4%, 16 of 44) (p < 0.05). The number of specimens obtained by piecemeal resection was slightly, but not significantly, higher with strip biopsy (2.4 +/- 1.7) than with endoscopic aspiration mucosectomy (2.0 +/- 1.7). The time required for treatment was similar for each procedure. The duration of hospitalization was significantly shorter with endoscopic aspiration mucosectomy (12.8 +/- 5.3 days) than with strip biopsy (15.9 +/- 74 days) (p < 0.05). As for complications, the rate of bleeding was 20. 5% (9 of 44) with strip biopsy and 10.2% (5 of 49) with endoscopic aspiration mucosectomy; bleeding was controlled in all cases by treatment with a heater probe.

CONCLUSIONS

Endoscopic resection of large gastric intramucosal tumors is easier with endoscopic aspiration mucosectomy compared with strip biopsy. Endoscopic aspiration mucosectomy is a useful procedure for en bloc resection.

Endoscopic mucosal resection with a cap-fitted endoscope versus freehand gastric mucosectomy in an animal model

BACKGROUND

Endoscopic mucosal resection with a cap-fitted endoscope appears to be as effective but easier to perform than freehand mucosectomy. However, experience with this technique has been limited to small case series and there is a lack of data from direct comparison trials.

METHODS

Nine pigs were randomized to mucosectomy using a cap-fitted endoscope or the freehand technique. Five mucosal resections were performed at five different sites in the gastric body in each pig. Eight to ten milliliters of a saline, epinephrine, and methylene blue solution were injected to raise a bleb to simulate a mucosal lesion. Endoscopic mucosal resection with a cap-fitted endoscope was performed by suctioning the bleb into the cap device pre-looped with an oval snare; mucosectomy was performed electrosurgically. Freehand mucosectomy was performed by encircling and then resecting the bleb using an oval snare. The ease of procedure (1 = "very easy" to 5 = "unable to complete") was assessed after each resection. The animals were recovered, maintained, and then humanely sacrificed after 2 weeks.

RESULTS

Five pigs underwent endoscopic mucosal resection with a cap-fitted endoscope and 4 underwent freehand mucosectomy. Eight animals survived for 2 weeks without complications and one animal from the freehand group died of massive hemorrhage within 48 hours of endoscopy. Both methods produced rounded resection specimens measuring 9 to 12 mm in diameter of the full thickness of the mucosa and the submucosa. Overall ease of resection was 1.84 +/- 0.52 for the cap-fitted group and 2.98 +/- 0.86 for the freehand group (p < 0.0001). All of the sites identified at autopsy were completely re-epithelialized, except for the five sites found in the pig that died prematurely.

CONCLUSIONS

Endoscopic mucosal resection with a cap-fitted endoscope is as effective, safe, but easier to perform compared with freehand mucosectomy.

Strip biopsy to treat esophageal granular cell tumor

Esophageal granular cell tumors are rare neoplasms. We successfully treated a 35-year-old Japanese man with an esophageal granular cell tumor without any complications using strip biopsy. Endoscopic ultrasonography revealed a hypoechoic tumor with a diameter of 8 mm that was confined to the submucosal layer. A strip biopsy done with a two-channel endoscope completely resected the tumor. Six months later, no abnormal findings were recognized in the resected area. Therefore we propose that strip biopsy be considered as a viable alternative treatment for esophageal granular cell tumor, depending on the histologic character, tumor size, and depth of tumor infiltration.

Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists

BACKGROUND

There have been many studies on gastric carcinoma in populations with contrasting cancer risks. We aimed to find out whether the criteria for the histological diagnosis of early gastric carcinoma were comparable in Western countries and Japan.

METHODS

Eight pathologists from Japan, North America, and Europe individually reviewed 35 microscope slides: 17 gastric biopsy samples and 18 endoscopic mucosal resections taken from 17 Japanese patients with lesions ranging from early gastric cancer to adenoma, dysplasia, and reactive atypia. The pathologists were given a list of pathological criteria and a form on which they were asked to indicate the criteria on which they based each diagnosis.

FINDINGS

For seven slides most Western pathologists diagnosed low-grade adenoma/dysplasia, whereas the Japanese diagnosed definite carcinoma in four slides, suspected carcinoma in one, and adenoma in only two. Of 12 slides with high-grade adenoma/dysplasia according to most Western pathologists the Japanese gave the diagnosis of definite carcinoma in 11 and suspected in one. Of six slides showing high-grade adenoma/dysplasia with suspected carcinoma according to most Western pathologists the Japanese diagnosed definite carcinoma in all. There were no major differences in the diagnoses of three slides showing reactive epithelium and seven slides with clearly invasive carcinoma. When the opinion of the majority of the pathologists was taken as the final diagnosis there was agreement between Western and japanese in 11 of the 35 slides (kappa coefficient 0.15 [95% CI 0.01-0.29]). Presence of invasion was the most important diagnostic criterion for most Western pathologists whereas for the Japanese nuclear features and glandular structures were more important.

INTERPRETATION

In Japan, gastric carcinoma is diagnosed on nuclear and structural criteria even when invasion is absent according to the Western viewpoint. This diagnostic practice results in almost no discrepancy between the diagnosis of a superficial biopsy sample and that of the final resection specimen. This may also contribute to the relatively high incidence and good prognosis of gastric carcinoma in Japan when compared with Western countries.

Endoscopic resection of gastrointestinal submucosal lesions: a comparison between strip biopsy and aspiration lumpectomy

BACKGROUND

Endoscopic diagnosis and treatment of gastrointestinal submucosal lesions is still not established. We evaluated the clinical usefulness of two resection methods for submucosal lesions, using a "nonrandomized surgeon" design.

METHODS

The strip biopsy method was evaluated at Tenri Hospital and the aspiration lumpectomy method was used at Kyoto University Hospital. The inclusion criteria for selecting patients were endosonographic findings indicating a tumor location within the submucosa.

RESULTS

Seventy-seven patients were treated. The size of the specimens (mean +/- SEM) was 20.7 +/- 0.9 mm for the aspiration lumpectomy group and 14.0 +/- 0.8 mm for the strip biopsy group (p < 0.01). Aspiration lumpectomy was adequate for a definitive histologic diagnosis in 95% of the cases (36 of 38) as compared with 77% (30 to 39) of the cases treated by strip biopsy (p = 0.047). The eradication rate was 87% for the aspiration lumpectomy group, and 74% for the strip biopsy group (p = 0.274). The complication rate resulting from these procedures (hemorrhage, mean 5%) was acceptable. Repeated endoscopic examinations revealed no recurrence except for one lymphangioma.

CONCLUSIONS

Endoscopic resection, especially aspiration lumpectomy, provides a significant benefit for accurate final diagnosis and eradication of submucosal lesions.