目的:内镜全层切除术(EFTR)治疗粘膜下肿瘤(SMTs)在技术上具有挑战性。这项回顾性研究旨在评估可行性,安全,EFTR对上消化道(GI)SMT的疗效,包括腔外病变.
方法:我们回顾性调查了2014年1月至2023年8月接受EFTR的232例SMT患者。临床病理特征,程序相关参数,不良事件(AE),并评估所有患者的随访结局.
结果:整块切除和整块R0切除率分别为98.7%和96.1%,分别。内镜下肿瘤平均大小为17.2±8.7mm,范围从6到50毫米。切除时间和缝合时间分别为49.0±19.4min和22.5±11.6min,分别。总之,39个病灶(16.8%)表现出主要的腔外生长。胃肠道间质瘤(GIST)是主要的病理,占病例总数的78.4%。21例患者(9.1%)出现并发症,包括气胸(1/232,0.43%),胸水(1/232,0.43%),局限性腹膜炎(3/232,1.29%),及发烧(16/232,6.9%)。尽管术后发热的发生率在主要的腔外组(7/39,17.9%)明显高于主要的腔内组(9/193,4.7%,P=0.008),EFTR程序的结局无显著差异.在平均3.7±2.3年的随访期内未观察到复发的实例。
结论:EFTR被认为是可行的,安全,对切除上消化道SMT有效,包括以腔外生长为主的病变。在前瞻性研究中需要进一步验证。
OBJECTIVE: Endoscopic full-thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions.
METHODS: We retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure-related parameters, adverse events (AEs), and follow-up outcomes were assessed in all patients.
RESULTS: The en-bloc resection and en-bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty-one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and
fever (16/232, 6.9%). Although the incidence of postoperative
fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, P = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow-up period of 3.7 ± 2.3 years.
CONCLUSIONS: EFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.