Efficacy Analysis Of Endoscopic Submucosal Excavation For Muscularis Propria Tumor Which Diameter Less Than 2cm

Background and Objective The muscularis propria tumor in digestive tract was often accidently found in gastroscopy.Most of the lesions are benign,but some of them are malignant or potentially malignant.There are some ways to deal with the lesions,especially for the gastrointestinal stromal tumors,such as surgery,chemotherapy and regular follow-up.However,there is no clear indication for endoscopic treatment.The research is to evaluate the efficacy and safety of submucosal excavation for gastrointestinal submucosal tumors originating form muscularis propria layer which diameter less than 2cm.Methods A total of 55 patients undergoing ESE in our department from 2013 to 2016 were analyzed retrospectively.The type of submucosal tumors and its location,en bloc resection rate,complication occurring rate were evaluated.The whole tumor biopsy was sent to take histological examination and used to determine the risk stratification.The Comparison of patients with anxiety before and after ESE was considered during the research.Complication of ESE was recorded and recurrence was investigated during regular follow-up.Results 55 cases with 54 cases were sucessfully performed and removed by one procedure.Surgery intervention was applied to 1 case because of severe tumor.The mean procedure time was 70.96±17.84min(42-102min).The average length of hospitalization was(12.95±5.72)days.The mean hospitalization cost was13163.17±7333.72 yuan.Perforation occurred in 10 patients(18.2%).All cases were closed with metal clips or OTSC clip.Gastrointestinal decompression,acid suppression with proton pump inhibitors and antibiotics were performed on cases,and none required surgical operation and were dead.Mild bleeding occurred in all cases,which was successfully managed by hot biopsy probe,electro-coagulation,argon plasma coagulation and mental clip.One case was complicated by postoperative delayed bleeding.Histological results showed 1 glomus tumor,25 leromyomas,1 hemangioma,1 schwannomas,27 gastrointestinal stromal tumors.The gastrointestinal stromal tumors were graded as extermely low risk in 18 cases,low risk in 7 cases and moderate risk in 2 cases.There were no pathological involvement in the base or along the incision edge.The patients were followed up for 1to 12 months,and no tumor residue or recurrence was observed.There was significant difference between the preoperative and the postoperative in 15 patients.The score of anxiety scale SAS and depression scale SDS before the ESE operation is higher than the after.Conclusion ESE is a safe and reasonable treatment method for muscularis propria layer which diameter less than 2cm,because of the advantages of small wound,rapid recovery,avoiding canceration and relieving stress.