Endoscopic Therapy For Submucosal Tumor Originating From The Muscularis Propria Layer Of The Upper Gastrointestinal Tract

Background:Gastrointestinal tract wall can be divided into mucosa, submucosa,muscularis propria and serosa in total of four layers,while upper gastrointestinal tract owns a thick muscularis propria. tumors originating from the muscularis propria layer of the upper gastrointestinal tract gastrointestinal submucosal tumors (SMTs) refer to a class of lesions which are originating from the organizations under the mucosa, such as submucosa and muscularis propria. Tumors belongs to mesenchymal neoplasms which include Gastrointestinal stromal tumor, leiomyoma,schwannoma, leiomyosarcoma and so on. Gastrointestinal stromal tumor and leiomyoma are common in clinical. The incidence of tumors originating from the muscularis propria layer in the upper gastrointestinal tract is increasing year by year and the age of onset has been younger. The level of discovery and diagnosis has been significantly improved with the popularity using of gastroscope and endoscopic ultrasonography (EUS). The majority of tumors originating from the muscular are propria layer in the upper gastrointestinal tract are benign lesions, but it will bring serious problems such as canceration, obstruction, bleeding and oppression of organs with the further growing of the tumor size. So it’s in need of early excision in clinical. Recently, endoscopic submucosal excavation (ESE),submucosal tunneling endoscopic resection(STER) and endoscopic full-thickness resection (EFR) have being used for the treatment of tumors originating from the muscularis propria layer in the upper gastrointestinal tract. Aim:To explore three common endoscopic therapy methods for the upper gastrointestinal tumors originating from the muscularis propria with the diameter less than3cm.Methods:For70cases diagnosed as the tumor originating from the muscularis propria layer in the upper gastrointestinal tract revealed in the examinations of gastroscope and ultrasound gastroendoscope from2011to2013, three types of endoscopic therapy methods were selected, based on the location and depth of the tumor. These methods included endoscopic submucosal excavation (ESE),submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFR). Immunohistostainining and molecular biology for CD34, CD117, Dog-1, S-100, smooth muscle actin (SMA),Ki-67and mitotic count were performed on the resected tumors.Results:A total of35cases were treated with ESE,two cases were complicated by perforation, and the perforations were closed with metal clips. Additionally,27cases were treated with STER, and no perforation occurred. Finally,8cases were treated with EFR, all of the cases were complicated by artificial perforation, and all of the perforations were closed with metal clips. All of the70cases recovered with medical treatment, and none found relapse. Immunohistostaining demonstrated that among all of the70tumors originating from the muscularis propria layer in the upper gastrointestinal tract diagnosed by gastroscopy,23cases were gastric stromal tumors, other46cases were gastric leiomyomas,and the other1case was schwannoma.Conclusion:Tumors originating from the muscularis propria layer in the upper gastrointestinal tract with the diameter less than3cm can be treated successfully with endoscopic techniques, which could replace certain surgical operations and should be considered for further application.