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Clinical outcomes of per‐oral endoscopic tumor resection for submucosal tumors in the esophagus and gastric cardia
Author(s) -
Onimaru Manabu,
Inoue Haruhiro,
Bechara Robert,
Tanabe Mayo,
Abad Mary Raina Angeli,
Ueno Akiko,
Shimamura Yuto,
Sumi Kazuya,
Ikeda Haruo,
Ito Hiroaki
Publication year - 2020
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13471
Subject(s) - medicine , esophagus , gastric tumor , surgery , myotomy , gist , endoscopy , stomach , stromal cell , achalasia
Objectives The clinical success of per‐oral endoscopic myotomy ( POEM ) has led to the development of a new field of ‘submucosal endoscopy’. This study aimed to evaluate the safety, efficacy, and limitations of per‐oral endoscopic tumor resection ( POET ) in the management of submucosal tumors ( SMT s) in the esophagus and the gastric cardia. Methods POET was performed in 47 patients from January 2011 to December 2017. The indication for POET was SMT s ≤ 30 mm in minor axis diameter. Patient and tumor characteristics (age, gender, tumor location, size, and histology), operative and clinical results of POET (procedure time and completion rate, en bloc resection rate, length of hospitalization, adverse events and tumor recurrence) were analyzed retrospectively. Results POET was successfully completed in 43 patients (91.5%) without any major adverse events (Clavien‐Dindo III b‐ IV ). Four patients required conversion to an open surgical procedure due to suboptimal visualization during POET . Four patients underwent piecemeal resection of their SMT s including GIST s. Median follow‐up was 44 months (10–96 months), during that time, there were no incidences of tumor recurrence. Tumors that had a minor axis diameter > 30 mm or a tumor mass index ( TMI ) [major axis diameter (mm) × minor axis diameter (mm)] >1000 had a high likelihood of being converted to surgical resection. Conclusions POET is a safe and effective treatment for SMT s. However, in patients where the minor axis diameter is > 30 mm or the TMI > 1000, surgical excision should be considered. Furthermore, application of POET for SMT s with malignant potential should be carefully considered to ensure optimal oncologic outcomes.