Submucosal Tunneling Endoscopic Resection Of Large Submucosal Tumors Originating From The Muscularis Propria Layer In The Esophagus And Gastric Cardia *

Aims The aim of this study was to evaluate the short-term complications of submucosal tunneling endoscopic resection (STER) for large submucosal tumors (SMTs) originating from the muscularis propria (MP) layer in the esophagus and gastric cardia. Methods We performed 286 cases of STER from September 2012 to December 2017. The clinical data of patients with SMTs originating from the MP layer of 3.0-7.0 cm, who underwent STER procedure at the endoscopy center of Tianjin Medical University General Hospital, were collected retrospectively. Epidemiological data, tumor location, tumor size, procedure-related parameters, complications, and follow-up were included. Results A total of 27 (9.4 % [27/286]) patients were large-size SMTs, with a mean age of 51.9 +/- 9.4 years. The male/female ratio was 19:8. Of the 27 SMTs, 23 were located in the esophagus and 4 in the gastric cardia. The mean tumor size was 4.0 +/- 1.1 cm. The en bloc resection rate was 85.2 % (23/27), and the complete resection rate was 100 % (27/27). Intra-operative perforation occurred in 2 patients (7.4 %) and post-operative perforation occurred in 2 patients (7.4 %). No other complications were observed. The average cost of the procedure was $3357.99 +/- $1171.60 per inpatient stay (including both the procedure and an additional inpatient stay). The mean follow-up time was 15 +/- 10.1 months. No recurrence and metastasis occurred during the follow-up period. Conclusions There is low risk of STER for the large-sized SMTs in the esophagus and gastric cardia, and the most common complication occurred during or after the procedure is perforation.