Endoscopic submucosa dissection for gastric submucosal tumor

Submucosal tumors (SMTs) are found in the gastric wall during endoscopy moreand more frequently. Strategies for the treatment of gastric SMTs is determined by the diameter of the tumor internationally. The patient is often advised to be observed and clinically followed up when the size of the tumor is less than 2 cm. Surgery is for the tumors which are more than 2 cm. But for the patients, long term follow-up will not only cause huge economic burden, also can bring heavy mental stress. Traditional surgery may bring huge wound, slow recovery, postoperative quality of life will also be affected. Furthermore, EUS can not reliably distinguish benign from malignant SMTs. So for the SMTs, the bigger ones (>2cm), which were qualitativly diagnosed benignor at borderline and the growth method are cavity growth, are strongly advised to be resected during endoscopy. The smaller ones (<2cm), if the patients have a strong willingness to resection, the tumors should be resected endoscopicly. From 2012 to 2013 we performed ESD on 384 patients with SMTs. Among them 34 for heterotopic pancreas, 43 for lipoma and 307 for leiomyoma.Sixteen patients with leiomyoma got perforation during the procedure and all of the wall defects were closed with metal clips. No patients transferredto opration. There were no residual tumor, local recurrence or distant metastasis during the period of follow-up.