Submucosal Tunneling Endoscopic Resection For The Treatment Of Esophageal Submucosal Tumors

Part ?.Comparison of submucosal tunneling endoscopic resection and surgery for the treatment of esophageal submucosal tumorsObjective:Submucosal tunneling endoscopic resection(STER)is increasingly used to treat esophageal submucosal tumors(SMTs).However,direct comparison of STER and surgery is rare.The aim of this study was to compare the efficacy and safety of STER with surgery in the treatment of esophageal SMTs.Methods:The clinical data of 54 patients treated with STER were compared retrospectively with that of 25 patients underwent open surgery and 10 patients underwent thoracoscopic enucleation.The en bloc resection rate was considered as the primary outcome.We also compared the operative time,estimated blood loss,complication,patient recovery and recurrence between the STER group and the surgery groups.In addition,subgroup analysis was performed according to whether the lesion was greater than 3 cm.Results:In term of en bloc resection rate,there was no significant difference between the STER group and the open surgery group and the thoracoscopic enucleation group(98.0%vs.96.0%,P=0.13;98.0%vs.100.0%,P=0.664).The median operative time in the STER group was significantly shorter than that in the open surgery group and the thoracoscopic enucleation group(81.5 vs.109.0 min,P=0.01;81.5 vs.114.0 min,P=0.02).Similarly,the median estimated blood loss in the STER group was significantly lower than that in the surgery group(3.0 vs.50.0 ml,P<0.001;3.0 vs.50.0 ml,P<0.001).In addition,the use rate of postoperative analgesics in the STER group was significantly lower than that in the surgery group(9.2%vs.52.0%,P<0.001;9.2%vs.50.0%,P=0.001).There was no significant difference between the STER group and the open surgery group in terms of complication rate,the proportion of patients with body temperature ?38?,perforation,mucosal injury,postoperative hospital stay,total hospital cost,reflux,dysphagia(P>0.05).Similar results were founded between the STER group and the thoracoscopic enucleation group(P>0.05).During the follow-up,no recurrence was found in the three groups,and the number of patients with chest pain in the STER group was significantly lower than that in the open surgery group(5.0%vs.60.0%,P=0.00).When the lesions were>3 cm,subgroup analysis showed no significant difference in the en bloc resection rate and median operative time between the STER group and the open surgery group(94.1%vs.94.1%,P=1;101.0 vs.101.0 min,P=0.885).The median estimated blood loss and analgesic use rate were significantly lower in the STER group than that in the open surgery group(3.0 vs.50.0 ml,P=0.00;5.9%vs.58.8%,P=0.001).The proportion of patients with body temperature ?38? was significantly higher than that of open surgery group(64.7%vs.23.5%,P=0.016).Conclusions:STER is a feasible treatment for esophageal SMTs.Compared with surgery,STER is associated with a shorter operative time,less blood loss and postoperative pain,without affecting the en bloc resection rate.As an alternate to surgery,STER is worthy of promotion in clinical practice.Part ?.Efficacy and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors:a systematic review and meta-analysisObjective:Endoscopic submucosal tunneling endoscopic resection(STER)is increasingly used to treat esophageal submucosal tumors(SMTs).The reported resection rate and the incidence of complications are not consistent.The aim of this study was to perform a meta-analysis to evaluate the efficacy and safety of STER in the treatment of esophageal SMTs in a systemic way.Methods:PubMed,Embase,Cochrane Library,Chinese Biomedical Literature database,China National Knowledge Infrastructure database,Wanfang and Weipu database were searched until December 25,2016.Studies used STER to treat esophageal SMTs were included.The en bloc resection rate and complete resection rate were considered as the primary outcomes.Complications and recurrence rate of each study were collected.Meta-analysis was performed using Open Meta-Analyst software.Results:A total of 463 patients from 22 studies were included in this meta-analysis.The pooled en bloc resection rate and complete resection rate were 97.5%(95.0%Cl:96.1-99.0%)and 97.3%(95.0%CI:94.7-99.8%),respectively.The common complications included air leakage symptoms and perforation;The incidence of air leakage symptoms was 13.4%(95.0%CI:8.2-18.7%),among which,subcutaneous emphysema and mediastinal emphysema were the most common,with a rate of 10.0%(95.0%Cl:6.2-13.9%);Pneumothorax,pneumoperitoneum rates were 6.0%(95.0%Cl:1.8-10.2%)and 5.0%(95.0%CI:1.1-9.0%),respectively.The incidence of perforation was 2.4%(95.0%CI:0.1-4.8%).In addition,4 studies reported a total of 4 cases(0.9%)of postoperative bleeding,and 1 study reported 2 cases(0.4%)of recurrence.Conclusions:STER is a feasible and safe treatment method for esophageal SMTs with high en bloc resection rates and complete resection rates.Air leak symptoms were the most common postoperative complications,and other common complications include perforation and bleeding.There were few cases of recurrence.