Endoscopic Submucosal Excavation For The Treatment Of Gastric Stromal Tumor From The Muscularis Propria Layer

Objective To explore the efficacy and safety of endoscopic submucosal excavation (ESE) for stromal tumors originating from gastric muscularis propria.Methods Gastric stromal tumor from the muscularis propria layer without metastasis was managed by ESE with the needle knife as following:(1)injecting fluid into the submucosa to elevate the lesion from the muscle layer,(2)pre-cutting the surrounding mucosa of the lesion,and (3)dissecting the connective tissue of the submucosa beneath the lesion.Results Of the20gastric stromal tumors from muscularis propria by EUS,10located in gastric fundus,8in gastric body,1in gastric angle,1in gastric antrum.Lesions ranged from0.5to4.3cm and a mean resected sizes was1.5cm.Among the20lesions,19were successfully resected with ESE,1receieved an additional operation because the lesion was closely connected with serosal and grew outside the stomach cavity,and the success rate of ESE was95.0%.None of the patients had delayed bleeding after ESE.Perforation occurred in2cases after the dissection of the lesions,which were typically closed with metallic endoclip without surgical treatment.Follow up period ranged from2to36months,and no reoccurrence was observed.Conclusions ESE is an effective and safe endoscopic surgical procedure to resect small GIST,which makes it possible to resect the whole lesion and provide pathologic information about the lesion.