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Geng ZH, Zhou PH, Cai MY. Submucosal Tunneling Techniques for Tumor Resection. Gastrointest Endosc Clin N Am 2023; 33:143-154. [PMID: 36375878 DOI: 10.1016/j.giec.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The concept of third space endoscopy is based on the principle that the deeper layers of the gastrointestinal tract can be accessed by tunneling in the submucosal space and maintaining the integrity of the overlying mucosa. The mucosal flap safety valve enabled endoscopists to use submucosal space securely. The era of third space endoscopy started with peroral endoscopic myotomy for treatment of achalasia and has expanded to treat various other gastrointestinal disorders, such as mucosal lesions, submucosal tumors, extraluminal tumors, and refractory gastroparesis, Zenker diverticulum, and restoration of the completely obstructed esophageal lumen. Third space endoscopy rapidly emerged as a minimally invasive alternative to conventional surgery. Many studies discovered that this technique is safe and effective with excellent outcomes. Our review focused on the indications, techniques, clinical management, and adverse events of submucosal tunneling techniques for tumor resection.
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Affiliation(s)
- Zi-Han Geng
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
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Zhang Y, Wen J, Zhang S, Liang X, Ren L, Wang L, Sun Y, Li S, Wang K, Lv S, Qiao X. Clinical study of submucosal tunneling endoscopic resection and endoscopic submucosal dissection in the treatment of submucosal tumor originating from the muscularis propria layer of the esophagus. Medicine (Baltimore) 2022; 101:e32380. [PMID: 36595766 PMCID: PMC9794317 DOI: 10.1097/md.0000000000032380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Herein, we aimed to evaluate the clinical value and safety of transendoscopic submucosal tunnel tumor resection (STER) and endoscopic submucosal dissection (ESD) for the resection of esophageal submucosal intrinsic muscle tumors. We retrospectively analyzed the clinical data of 68 patients with esophageal submucosal intrinsic muscle tumors treated with STER (STER group, n = 38, March 2018 to January 2020) or ESD (ESD group, n = 30, January 2017 to January 2020) at the First People's Hospital of Lianyungang to compare the treatment efficacy, hospitalization time and costs, and postoperative complications between the 2 groups. All 68 cases were of single lesions. The mean operative duration was shorter in the STER group (53.39 ± 11.57 min) than in the ESD group (68.33 ± 18.52 min, P < .05). The postoperative hospital stay duration was significantly shorter in the STER group (5.86 ± 1.01 days; P < .05) than in the ESD group (8.2 ± 3.4 days, P < .05). The mean hospitalization cost was significantly lower in the STER group than in the ESD group (12,468.8 + 4966.8 yuan vs 17,033.3 ± 4547.2 yuan; P < .05). Only 1 case of intraoperative perforation occurred in ESD group. There were no other complications in both groups. The wound healed in both groups, and no residual or recurrent tumors were detected during the follow-up period. Both STER and ESD can be used for the treatment of esophageal intrinsic muscular layer (MP) tumors, and STER is safer and more efficient for lesions with a diameter <3.5 cm.
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Affiliation(s)
- Yue Zhang
- Jinzhou Medical University, Jiangsu, China
| | - Jing Wen
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Shuxian Zhang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xuyang Liang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Ling Ren
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Lu Wang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yunliang Sun
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Shouying Li
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Kun Wang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Shengxiang Lv
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- * Correspondence: Shengxiang Lv, Department of Gastroenterology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang 222000, China (e-mail: ) and Xiao Qiao, Department of Gastroenterology, Huai'an Hospital, Xuzhou Medical University, Huai'an, Jiangsu 223002, China (e-mail: )
| | - Xiao Qiao
- Department of Gastroenterology, Huai’an Hospital of Xuzhou Medical University, Jiangsu, China
- * Correspondence: Shengxiang Lv, Department of Gastroenterology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang 222000, China (e-mail: ) and Xiao Qiao, Department of Gastroenterology, Huai'an Hospital, Xuzhou Medical University, Huai'an, Jiangsu 223002, China (e-mail: )
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