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Endoscopic enucleation of upper-GI submucosal tumors by using an insulated-tip electrosurgical knife

 Young Soo Park  ;  Seung Woo Park  ;  Jin Kyung Kang  ;  Jae Bock Chung  ;  Eric Hoon Choi  ;  Si Young Song  ;  Tae Il Kim 
 GASTROINTESTINAL ENDOSCOPY, Vol.59(3) : 409-415, 2004 
Journal Title
Issue Date
Adult ; Aged ; Electrosurgery/instrumentation* ; Electrosurgery/methods ; Endosonography/methods ; Equipment Design ; Equipment Safety ; Esophageal Neoplasms/diagnostic imaging ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery* ; Esophagoscopy/methods* ; Female ; Follow-Up Studies ; Gastric Mucosa/pathology ; Gastroscopy/methods* ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Assessment ; Sampling Studies ; Stomach Neoplasms/diagnostic imaging ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Surgical Instruments ; Treatment Outcome
Submucosal tumors often are found incidentally at upper endoscopy. Although the majority of the ones less than 5 cm in size are benign, periodic monitoring for incremental changes in size, which can be stressful and bothersome to patients, is essential. If relatively easy and safe, an endoscopic method of removal would be optimal treatment. Conventional endoscopic enucleation technically is difficult and often leads to serious complications, such as bleeding and perforation. A novel method for endoscopic enucleation of submucosal tumors with an insulated-tip electrosurgical knife is reported.
En bloc enucleation was attempted by using an insulated-tip electrosurgical knife in 15 patients (10 men, 5 women; median age 48 years) with submucosal tumors of the esophagus (5) or stomach (5 cardia/fundus, 4 body, one antrum). EUS was performed to determine the layer of origin and the exact size of the submucosal tumor.
Tumors arose in the muscularis propria in 11 cases, submucosa in two, and muscularis mucosa in one. Enucleation was relatively easy and successful in 14 cases. In one case, however, piecemeal resection was unavoidable because of fibrotic adhesions with the surrounding tissue; this tumor later was confirmed to be a glomus tumor. Median procedure time was 35 minutes (8-180 minutes) and median size of the submucosal tumors was 2x1.7 cm. The largest lesion, located in the esophagus, measured 6x3 cm. Histopathologic diagnoses included leiomyoma (9), GI stromal tumor (4), stromal tumor of unknown malignant potential (1), and glomus tumor (1). A small perforation occurred in one patient with a 2.5-cm tumor in the anterior wall of proximal gastric body but was managed successfully by endoscopic clip application. Follow-up endoscopy at 2 months in this patient revealed no tumor recurrence and complete healing of the treatment-related ulcer.
En bloc endoscopic enucleation of submucosal tumors by using an insulated-tip electrosurgical knife appears to be safer, easier, and less time consuming compared with previously described methods. However, further investigation and comparative studies are required to confirm the safety and efficacy of this method.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Park, Seung Woo(박승우) ORCID logo https://orcid.org/0000-0001-8230-964X
Song, Si Young(송시영) ORCID logo https://orcid.org/0000-0002-1417-4314
Chung, Jae Bock(정재복)
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