Long-term Outcomes Of Endoscopic Resection For Gastric Subepithelial Tumors

Objective This study aimed to analyze the safety and effectiveness of endoscopic resection as a treatment for gastric submucosal tumors using long-term patient outcome data.Methods A retrospective analysis was performed including a total of 73 consecutive patients treated for gastric subepithelial tumors(SETs)between June 2014 and December 2016 at our institution.Treatments were ESD,ESE or endoscopic full-thickness resection(EFTR).Clinicopathological,endoscopic,and follow-up data were analyzed in addition to epidemiological data(gender,age),tumor size,procedure-related parameters,complications,length of stay,and cost data in order to compare treatments.Statistical analysis:quantitative data(age,lesion size,etc.)were described as mean ± SD and were compared by independent t test.Categorical variants(gender,complete resection rate,post-operative adverse events,etc.)were analyzed by Chi square test,and Fisher exact probability test.A p value <0.05 was considered statistically significant.All analyses were performed with SPSS statistical software package(SPSS 22.0 version,Chicago,IL,USA).Results The complete resection rate was 97.3%(71/73).Three patients experienced complications(4.1%),including two with delayed perforation and one with perioperative infection.The median post-operative feeding time was three days and median post-operative hospital stay was five days.The median follow-up period was 19 months with no patient deaths or tumor recurrence.Among the 38 patients with gastric stromal tumors,the complete resection rate was 97.4%(37/38).Based on histological examination,33 patients were classified as low-risk or very low-risk,four as moderate-risk,and one as high-risk.The ESE group had the same complete resection and complication rate as the EFTR group.There was no recurrence or metastasis detected among either group,however the ESE group had earlier post-operative feeding,shorter postoperative hospital stays,and less hospitalization expense.Conclusion Endoscopic resection for gastric subepithelial tumors(<3cm)is safe and feasible in terms of medium-term and long-term effects.Compared with EFTR,the patient group treated with ESE had earlier post-operative feeding,shorter postoperative hospital stays,and less hospitalization expense.Although complete resection was preceded by endoscopic treatment,gastric SETs with malignant potential have a risk of recurrence.Larger prospective multicenter studies are warranted.