Clinical Efficacy Analysis Of Modified Endoscopic Submucosal Dissection For Small Gastric Stromal Tumors

Objective:The objective of this study was to evaluate the safety and efficacy of Modified endoscopic submucosal dissection(MESD)and traditional endoscopic submucosal dissection(ESD)in the treatment of 78 cases of small gastric stromal tumors(GSTs)with diameter ?2cm,and to analyze the safety and efficacy of modified endoscopic submucosal dissection for gastric stromal tumors.Methods:This study retrospectively analyzed the clinical data of 78 cases of small gastric stromal tumors(diameter<2cm)treated by ESD or MESD from January 2014 to January 2018 in the department of gastroenterology of the second people's hospital of yunnan province,including 36 cases in the ESD group and 42 cases in the MESD group,Inductive analysis of the general data of the two groups(including age,gender,clinical manifestations,tumor size,tumor location),intraoperative related indicators(including surgical operation time,intraoperative bleeding or perforation rate and complete tumor resection rate),pathology results,postoperative recovery(including postoperative delayed hemorrhage,hospital stays,hospitalization expenses,follow-up results,At the same time,the operation time,complete resection rate of tumor,intraoperative and postoperative major complication rate(bleeding,perforation),postoperative hospital stay,hospitalization cost and other indicators were compared by comparing the two groups of patients(ESD group and MESD group),To analyze the advantages and disadvantages of modified ESD surgery compared with traditional ESD surgery All patients underwent gastroscopy 3 months after surgery to observe the healing of the wound.Then,the gastroscope was reviewed once every 6 months to observe whether the tumor had recurrence.The whole abdominal CT was performed once a year to observe whether the tumor had distant metastasis.To evaluate the long-term efficacy of ESD and MESD in the treatment of gastric stromal tumors.Results:1?General information:among the 78 cases of patients diagnosed with gastric stromal tumor through pathology,the clinical manifestations were mostly chronic gastritis or gastrointestinal bleeding symptoms,and a small number were found during physical examination.Among them,59 cases(75.64%)had upper abdominal discomfort,3 cases(3.85%)had nausea,belching and abdominal distension,2 cases(2.56%)had black stool,3 cases(3.85%)had retrosternal obstruction,11 cases(14.10%)had asymptomatic physical examination(via abdominal CT or gastroscopy),The tumor originated from 66 cases of gastric fundus,8 cases of gastric body and 4 cases of gastric antrum.Among the 78 patients,42 were male and 36 were female,and the ratio of male to female was 1.2:1.The maximum age was 78 years old,the minimum age was 19 years old,and the average age was 55.56±11.03 years old;The tumor diameter ranged from 0.6cm to 2.0cm,and the average tumor diameter was 1.11±0.32cm.There was no significant difference in age,sex or tumor diameter between the two groups(P>0.05).2?Surgical data:The patients in the ESD group and the MESD group were completely resected,and the success rate was 100%.36 patients in the ESD group and 42 patients in the MESD group had intraoperative bleeding of varying degrees,ranging from 5-20ml,and electrocoagulation to stop bleeding.I.n the ESD group,there were 3 patients(8.33%)with intraoperative perforation,and in the MESD group,there were 5 patients(10.42%)with intraoperative perforation.The perforators were successfully closed by metal titanium clamp or purse-string suture.There were 2 cases(5.56%)with delayed bleeding in ESD group and 2 cases(4.76%)with delaye bleeding in MESD group.All patients were successfully hemostasis after endoscopic treatment.78 cases of patients were successfully operated,and no one was transferred to surgery.There was no significant difference in the incidence of major complications(bleeding,perforation)and complete resection rate between the two groups(P>0.05).The average operation time of ESD group was 51.56±7.92 min,and the average length of hospital stay was 6.64±0.68 days,the average hospitalization cost was 22363.80±1677.87 yuan;the average operation time in the MESD group was 39.24±4.90 min,the average length of hospital stay was 6.95±0.83 days,and the average hospitalization cost was 22008.59±1335.71 yuan;the MESD operation time was less than the ESD group,and the difference was statistically significant(P<0.05).There was no significant difference in the average hospitalization cost and the average hospital stay(P>0.05).3?postoperative pathology and follow-up:78 cases of patients with postoperative pathologic and immunohistochemical diagnosis of GST,including 78 patients(100%)with CD117 positive,78 patients(100%)with DOG-1 positive,and 72 patients(100%)with CD34 positive,45 cases(57.69%)were positive for Ki-67,49 cases(62.82%)were positive for Nestin,10 cases(12.82%)were positive for S-100,and 11 cases(14.10%)were positive for SMA.All 78 cases of patients were classified as very low risk according to the 2008 NIH classification criteria.All patients were followed up for the shortest follow-up period of 12 months,the median follow-up time was 22 months,and the longest follow-up time was 48 months.There were no follow-ups during the follow-up,and no deaths were observed during the follow-up period.The follow-up rate was 100%.The follow-up results showed that 78 patients had good wound healing after surgery,and no tumor recurrence and distant metastasis were observed.Conclusion:1.For gastric stromal tumors with diameter?2cm,both traditional ESD and modified ESD can guarantee the complete resection of the lesion while retaining the normal anatomical structure of the stomach,and at the same time have the advantages of less trauma,less bleeding,fewer complications and faster postoperative recovery.No tumor recurrence or distant metastasis was observed in the long-term follow-up of 78 cases of patients,indicating that ESD and MESD have good long-term efficacy in the treatment of gastric stromal tumor.It indicates that traditional ESD or modified ESD is a safe and effective minimally invasive method for the treatment of gastric stromal tumor.2?MESD has the advantages of short operation time compared with traditional ESD.At the same time,for flat basement,small tumor size or exogenous gastric stromal tumor,MESD is more convenient for operation,Surgical methods can be selected according to tumor location,tumor size,growth pattern,tumor origin site and physician experience.