Comparison And Analysis Of Endoscopic Submucosal Excavation And Submucosal Tunneling Endoscopic Resection For The Treatment Of The Esophagogastric Junction Submucosal Tumor

Objective:To compare and analyze the safety and efficacy of ESE and STER techniques for treating SMT of EGJ,and to explore the clinical application value of two kinds of endoscopic surgery,and summarize the experience,so as to provide a reference for the choice of treatment options for patients in the future.Methods:We reviewed and collected the medical records of patients who underwent ESE and STER treatment of SMT in the EGJ at the digestive endoscope center of our hospital between January 2012 and December 2018,and categorized into ESE group and STER group.Clinical characteristics were collected including sex,age,tumor number,tumor size,tumor shape,origin depth,pathological results.Operation details were collected including the enbloc rate,operation time,surgical complications.According to the clinical and pathological data,the subgroup analysis was conducted,and to explore the risk factors of surgical complications.Results:1.54 cases were included in this study,25 males and 29 females,with an average age of 53.22 ± 7.94 years and an average tumor diameter of 18.63 ± 10.20 mm.All tumors originated from the muscularis propria,including 32 cases of the superficial layer of the intrinsic muscle and 22 cases of the deep layer of the intrinsic muscle.The postoperative pathological classification: leiomyoma in 36 cases(66.7%),GIST in 17 cases(31.5%),schwannoma in 1 case(1.9%).2.There was no significant difference in enbloc resection rate between the STER group and the ESE group(100.0% VS 96.7%,P> 0.05);the overall complications in the STER group were lower than those in the ESE group(20.8% vs 46.7%,P < 0.05),but the gas complications in the STER group were relatively higher(12.5% vs 3.3%),compared with ESE,the operation time in the STER group was shorter(68.54 ± 22.29 min vs 87.40 ± 24.58 min,P <0.05)and shorter hospitalization time(6.96 ± 1.65 days vs 8.83 ± 2.57 days,P < 0.05).3.For SMT with diameter ? 20 mm,compared with ESE,the operation time of STER group was shorter(72.90 ± 20.06 min vs 92.23 ± 16.55 min,P < 0.05),the incidence of intraoperative bleeding was lower(46.2% vs 0,P < 0.05),and the hospitalization time was shorter(7.00 ± 1.89 days vs 9.15 ± 2.73 days,P < 0.05);for SMT with diameter < 20 mm,there was no significant difference between the two treatment methods.4.The median follow-up time was 16.5 months in the ESE group and 17.5 months in the STER group.During the follow-up period,there was no recurrence or residual case in the two groups.5.Single factor analysis combined with logistic regression analysis showed that the larger the tumor,the deep layers of the intrinsic muscle and the irregular shape were the risk factors for the complications(P < 0.05).Conclusions:1.STER and ESE are safe and effective in the treatment of SMT in the EGJ,but the overall complications of STER group are lower,the risk of intraoperative bleeding and perforation is lower,and the operation time and hospitalization time are shorter.2.This study shows that the larger the tumor,the deep layers of the intrinsic muscle and the irregular shape are the risk factors of surgical complications.