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Korean J Gastrointest Endosc > Volume 36(4); 2008 > Article
Korean Journal of Gastrointestinal Endoscopy 2008;36(4): 193-199.
상부소화관 점막하 종양의 일괄 절제를 위한 내시경 종양하 박리법의 유용성
윤효중ㆍ유창범ㆍ나현식ㆍ맹주희ㆍ한상훈ㆍ고봉민ㆍ홍수진ㆍ조주영ㆍ이준성ㆍ이문성ㆍ심찬섭ㆍ김부성
순천향대학교 의과대학 내과학교실
The Usefulness of Endoscopic Subtumoral Dissection for En-bloc Resection of Upper Gastrointestinal Submucosal Tumors
Hyo Joong Yoon, M.D., Chang Beom Ryu, M.D., Hyun Sik Na, M.D., Ju Hee Maeng, M.D., Sang Hoon Han, M.D., Bong Min Ko, M.D., Su Jin Hong, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.
Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
Abstract

Background/Aims:
The removal of esophageal and gastric submucosal tumors is difficult using conventional endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors.
Methods:
An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal tumors (M:F=10:5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal dissection.
Results:
Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5×21.1 mm. The mean procedure time was 49.4 minutes (range: 8∼103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery.
Conclusions:
An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin. (Korean J Gastrointest Endosc 2008;36:193-199)
Key Words: Submucosal tumor, Endoscopic subtumoral dissection, En-bloc resection
주요어: 점막하 종양, 내시경 종양하 박리법, 일괄 절제
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