Endoscopic Ultrasonography In Guiding Endoscopic Treatments Of Gastric Submucosal Tumors Originating From Muscularis Propria

Objective:To investigate whether endoscopic ultrasound(EUS)feathers were related to the complications in endoscopic resections of gastric submucosal tumors originating from muscularis propria,and access the guiding value of EUS on endoscopic treatments of gastric submucosal tumors in muscularis propria.Methods:254 patients who were diagnosed as gastric submucosal tumors originating from muscularis propria by EUS and underwent endoscopic treatment in our endoscopy center from January 2014 to July 2017 were analyzed retrospectively.We analysed the risk factors of the complications in endoscopic resections.According to the analysis results,the cases were divided into three groups with different EUS feathers.Subgroup analysis was performed in each group to evaluate therapeutic outcomes of different endoscopic treatments.Endoscopic treatments were classified as traditional ways of resection,new ways of resection and EBL.Traditional ways include endoscopic submucosal dissection(ESD),endoscopic submucosal excavation(ESE)and snare resection.New ways include submucosal tunneling endoscopic resection(STER)and endoscopic full-thickness resection(EFTR).Results:Results of the Univariate analysis showed that occurrence of complications was influenced by the size and extraluminal growth pattern of the tumor.Multivariate logistic regression analyses identified tumor size>2cm(OR:3.598,95%CI:1.305-9.918,P = 0.013)as an independent risk factor correlated with occurrence of complications in endoscopic resections.Extraluminal growth pattern may have an influence on the adverse events,but not an independent risk factor(OR:2.102,95%CI:0.964-4.583,P = 0.066).Subgroup analysis showed that,for lesions>2cm and/or growing extraluminally,incidences of complications were significantly lower in new ways group than traditional ways group.Duration of fasting,anti-infective therapy,hospital stay and procedure time were shorter in new ways group significantly(P<0.05).For lesions<1cm and growing intraluminally,incidences of complications were significantly lower in EBL group than traditional ways group(P<0.05).Duration of fasting,anti-infective therapy,hospital stay and procedure time were significantly shorter in EBL group than traditional ways group(P<0.05).Similar therapeutic outcomes were founded between the new ways and traditional ways of resection for lesions between 1 to 2cm and growing intraluminally.But the hospitalization cost of traditional ways group was significantly less than the new ways group(P<0.05).Conclusions:EUS can guide endoscopic treatments of gastric submucosal tumors originating from muscularis propria.Tumor size>2cm was an independent risk factor correlated with occurrence of complications in endoscopic resections.For lesions>2cm and/or growing extraluminally,STER or EFTR maybe an appropriate treatment.For lesions between 1 to 2cm and growing intraluminally,ESD or ESE or snare resection is recommended.For lesions<1cm and growing intraluminally,EBL can achieve satisfactory therapeutic outcomes.