Introduction Submucosal lesions are a relatively common finding at upper gastrointestinal endoscopy. Endoscopic resection (ER) may be warranted in larger lesions, those causing symptoms or those with malignant potential. However submucosal origin makes these lesions difficult to resect by an endoscopic approach. Advances in resection techniques have made this feasible.
Methods Portsmouth Hospitals is a tertiary referral centre for advanced ER. All ER procedures between 2005 and 2011 were recorded in a prospective database. We analysed our database to identify all submucosal lesions removed by ER in the past 7 years. All procedures were carried out by a single skilled endoscopist. Demographic data, histology, procedure success, long-term outcome and complications were assessed.
Results A total of 161 lesions were treated by UGI ER between 2005 and 2011. 14 of 161 were submucosal lesions. Nine of the 14 patients were female and the mean age was 54.3 years (range 34–69 years). Five lesions were located in the oesophagus, seven in the stomach and two in the duodenum. Histology revealed granular cell tumour (3), neuroendocrine tumour (5), inflammatory fibroid polyp (2), lipoma (2), gastrointestinal stromal tumour (1), Leiomyoma (1). All cases were successfully treated in a single ER session of which 6 cases were treated by conventional EMR, 9 by ESD techniques. The single complication was a microperforation during ESD of an oesophageal GIST which was endoscopically clipped. The patient was managed conservatively with intravenous antibiotics and was discharged after 3 days. There were no cases of significant bleeding and no patient required surgery. After a mean follow-up of 19.5 months all patients remain well and have no signs of recurrence.
Conclusion The caseload of UGI ER for submucosal lesions in low with an average of two cases per year in a large UK specialist centre. The majority of cases required ESD skills and therefore these cases should be treated in specialist centres with expertise in this technique. Outcomes and complication rates were acceptable in this small series and major surgery was avoided in these patients reducing costs and bed occupancy.
Competing interests None declared.
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