Evaluation Of The Efficacy And Complications Of Endoscopic Treatment Of 240 Cases Of Upper Gastrointestinal Submucosal Tumors

Objective:To explore the clinical characteristics of upper gastrointestinal submucosal tumors(SMT)and clinical factors affecting postoperative complications and hospitalization costs of SMT patients.Methods:The clinical data of 240 SMT patients treated in Shandong Provincial Hospital during Jan.2012 and June 2019 were collected,and the clinical characteristics,pathological types,treatment modalities and therapeutic effects were analyzed.Results:The patients included 101 male(42.1%)and 139 female(57.9%),mean age 54.19 years,and mean size of SMT 1.12 cm.The tumors were located in the esophagus in 57(23.8%)cases,in the gastroesophageal junction in 17(7.1%)cases,in the stomach in 163(67.9%)cases,and in the duodenum in 3(1.3%)cases.Endoscopic submucosal dissection(ESD)was performed in 69(28.8%)patients,endoscopic submucosal excavation(ESE)in 117(48.8%)patients,endoscopic full-thickness resection(EFR)in 28(11.7%)patients,and submucosal tunneling endoscopic resection(STER)in 26(10.7%)patients.The main pathological types were leiomyoma(117,49.2%)and stromal tumor(78,32.8%).Altogether 237 patients(98.8%)were successfully treated,with 90.4%(217/240)en bloc resection rate.The mean operation time was 58.37 minutes,hospital stay 10.07 days,and hospitalization costs 35830.3 yuan.Complications were observed in 17(7.1%)patients,10(4.2%)of whom relieved after conservative treatment and 7(2.9%)received active interventions such as endoscopic hemostasis,gastrointestinal decompression and puncture drainage.No death or long-term complications occurred.Operation time≥55min and SMT≥2cm were the risk factors of postoperative complications;meanwhile,operation time ≥55min,SMT≥2cm,failure of en bloc resection and use of OTSC increased hospitalization costs.Conclusion:1.Upper gastrointestinal SMT is common in the stomach and esophagus,especially the fundus of the stomach,and less common in the duodenum.The pathological types is mainly leiomyomas and stromal tumors,most of which are benign lesions.And the lesions ≤2cm still have the potential for malignant transformation and require regular follow-up;2.ESD,ESE,EFR,STER all demonstrate satisfactory therapeutic effects and low postoperative complication rate without statistical difference between them.Patients with ESD And ESE have shorter operation time,shorter hospitalization days and less hospitalization costs.3.Operation time≥55min and SMT≥2cm are important factors affecting postoperative complications,suggesting that we need to improve endoscopic screening of SMTs to promote early detection,early diagnosis and treatment of SMT patients.Besides,we need to improve the surgeon’s operation ability to shorten the operation time to reduce the incidence of postoperative complications.For SMT patients with SMT>2cm and operation time≥55min,we must pay attention to the postoperative complications and deal with them timely.4.Operation time≥55min,SMT≥2cm,failure of en bloc resection and use of OTSC increased hospitalization costs of SMT patients,which indicates that we need to improve the ability of endoscopic screening and remove the lesions as early as possible,and at the same time improve the surgeon’s operation ability to shorten the operation time and increase the rate of en bloc resection to reduce the cost of hospitalization.