Our challenge of Endoscopic Resection for gastric submucosal tumor

【Background】
Endoscopic resection (ER) for submucosal tumors (SMTS) is one of the advanced endoscopic techniques. To overcome this challenging endoscopic therapy, minimize defect and securely closing method are demanded. As a counter measure, For resection, Endoscopic muscularis/subseroral dissection (EMD/ESSD), endoscopic full-thickness resection (EFTR) and per-oral endoscopic tumor resection (POET) were chosen on the basis of the tumor origination, size, and location. And for closure methods, we applied conventional clips, Over the scope clips (OTSC), purse-string suture method using an endoloop and Full thickness Suturing device (Zeosuture).
【Aim】
The aim of this study was to assess the clinical outcomes of ER for G-SMTS. 20 patients between 2014 and 2020 were enrolled. Clinicopathological characteristics and clinical outcomes were evaluated retrospectively.
【Results】
The tumor location was at U14/M5/L1. 6 EMD/ESSD, 11 EFTR and 3 POET were performed. And the defect was endoscopically closed with clips (8), purse-string suture method using an endoloop (3), OTSC (7), suturing device(1). The tumor size was 22.5 mm, and the resected specimen size was 29.8mm. The mean procedure time was 72.0 minutes. The length of hospital stay was 7.7 days. En-bloc resection was achieved in all cases. Final pathological diagnosis was 14 GISTs, 6 others.
【Conclusion】
We confirmed favorable clinical outcomes of ER for selected cases of SMT. On the other hand, the strategy differs from each cases and standardization is still premature. Therefore, further investigation is demanded.