Analysis On Pathological Features And Endoscopic Treatments Of Upper Gastrointestinal Submucosal Tumors Originating From The Muscularis Propria Layer

AIM:To analyze the pathological characteristic and treatment of the submucosal tumors originating from the muscularis propria layer in different upper gastrointestinal location.METHODS:Pathological and clinical data of 101 cases which is diagnosed upper gastrointestinal SMTs originating from the muscularis propria layer in endoscopy center of China-Japan union hospital of jilin university by endoscopy and endoscopic ultrasonography(endoscopic ultrasonography,EUS)from February 2016 to July 2019 is retrospectively analyzed to discuss its pathologies and treatments.RESULTS:There were 101 cases included.There were 8 cases treated with ESE for intracavity growth and the others treated with STER in 28 esophagus and cardiac cases.leiomyoma(92.9%,26/28)was the most common type of esophageal and cardiac SMTs originating from the muscularis propria layer.There were 24 cases treated with EFTR for excentric growth and the others treated with ESE in 73 gastric cases.The common type of gastric SMTs originating from the muscularispropria layer were 43 GISTs(58.9%,43/73),27(37.0%,27/73)leiomyoma and 3 schwannomas(4.1%,3/73).Except for one case in gastric fundus,which was found to be too deep and not clearly separated from the serous membrane during ESE treatment,and was transferred to surgical treatment,other cases were successly excised.No local recurrence and distant metastasis were founed during the follow up.Conclusion:The upper gastrointestinal SMTs originating from the muscularis propria layer under 4cm can be completely removed by endoscopy,with few complications,no recurrence and high quality of life of the patients,which is commonly recommendaed.Esophageal and cardiac SMTs originating from the muscularis propria layer are mainly leiomyomas,the first choice is STER especialy for those under 3.5cm and ESE only used when mainly intracavitary growth.Gastric SMTs originating from the muscularis propria layer are mainly GISTs.It is recommended to undergo EFTR which is extracavitary growth and ESE the others which is intracavity or mixed growth in Gastric SMTs originating from the muscularis propria layer.