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Abstract
Background There is still controversy about the resection for gastric, small submucosal tumors (SMTs) originating from the muscularis propria layer. Among different gastric areas, the fundus is regarded as the most difficult for endoscopic resection (ER). In this study, we aimed to investigate the clinicopathological characteristics and assess the efficacy and safety of ER for small SMTs in the gastric fundus.
Methods 255 consecutive patients with 259 gastric SMTs≤20mm in diameter in the fundus and originating from the muscularis propria layer who underwent endoscopic submucosal excavation (ESE) or endoscopic full-thickness resection (EFTR) or laparoscopic resection at the First affiliated hospital of Soochow university from January 2015 to December 2022 were enrolled. ESE and EFTR procedures are shown in Figure 1 and Figure 2, respectively (IDDF2024-ABS-0114 Figure 1. ESE operation process for treating SMTs in the gastric fundus, IDDF2024-ABS-0114 Figure 2. EFTR operation process for treating SMTs in the gastric fundus). Clinicopathological characteristics and endoscopic data were collected and analyzed.
Results 257 SMTs were successfully resected by ESE or EFTR, and two patients switched to laparoscopic resection. Complete resection was achieved in 100% of lesions. Although the total complication rate was 5.5%, few serious adverse events occurred in only one patient presenting with bleeding. Of all small SMTs in the gastric fundus, gastrointestinal stromal tumors (GISTs) accounted for 66.0% (171/259), of which the majority (99.4%, 170/171) were graded as very low or low risk according to the National Institutes of Health (NIH) GIST risk stratification guideline. Compared with the non-GISTs group, GISTs occurred in elderly male patients and located in the greater curvature of gastric fundus more frequently, and the proportion of EFTR and procedure time≥60 minutes were relatively higher in the GISTs group.
Figure 1 ESE operation process for treating SMTs in the gastric fundus.A Small submucosal tumor observed by endoscopy. B The mucosa was incised along the lesion. C Artificial ulcer was presented after lesion was resected. D Metallic clips were placed for deeply resected areas.
EFTR operation process for treating SMTs in the gastric fundus.A Small submucosal tumor observed by endoscopy. B The mucosa was incised along the lesion. C Active perforation was made and gastric wall defect was presented after lesion was resected. D Metallic clips interrupted suture with endoloop were used to close the wall defect.
Conclusions ER is effective and safe for the resection of small SMTs in the gastric fundus. Considering the probability of GISTs, ER should be preferred when small SMTs are detected in the gastric fundus, especially in the greater curvature.