Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

作     者：Yu ZHANG Zhen WANG Ting JIN Kai-qiang LI Ke HAO WeiZHANG Bao-ying FEI 

作者机构：Department of Gastroenterology Zhejiang Provincial People's Hospital People's Hospital of Hangzhou Medical College Hangzhou 31 O014 China Department of Gastroenterology Tongde Hospital of Zhejiang Province Hangzhou 310012 China Department of Gastroenterology the First People's Hospital of Xiaoshan District Hangzhou 311200 China 

出 版 物：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》 (浙江大学学报（英文版）B辑（生物医学与生物技术）)

年 卷 期：2017年第18卷第8期

页      面：707-716页

核心收录：

学科分类：0710[理学-生物学] 1007[医学-药学(可授医学、理学学位)] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 0905[农学-畜牧学] 0906[农学-兽医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Gastric submucosal tumor Endoscopic submucosal dissection Endoscopic full-thickness resection Muscularis propria 

摘      要：Minimally invasive endoscopic resection has been rapidly adopted as a new technique for treating patientswith gastric submucosal tumors （SMTs） originating in the muscularis propria （MP） layer. This study was conducted toevaluate the information obtained from endoscopic ultrasonography （EUS） to determine the appropriate endoscopicdissection method for treating SMTs originating in the MP layer. Between February 2014 and May 2016, a total of 50patients with gastric SMTs originating in the MP layer were enrolled in this study. The clinical features of the patientsand their endoscopic, EUS, and histopathologic findings, as well as their postoperative follow-up data, were analyzedin this retrospective study. The mean age of the patients was （55.0±10.2） years, and the male/female ratio was 17：*** submucosal dissection （ESD） was performed on 43 patients and an endoscopic full-thickness resection（EFR） was performed on seven patients. The most frequent location for an SMT was in the upper body region of thestomach （n=16）, and the most common pathological diagnosis was a gastrointestinal stromal tumor （GIST） （n=32）.The overall rates for complete resection were 95.3% （41/43） and 100.0% （7/7） when the SMTs were treated by ESDand EFR, respectively. The presence of a complete tumor capsule was significantly associated with a complete re-section （P=0.001）. Of the cases treated by ESD, nine patients developed perforation, one of whom required laparo-scopic surgery. The remaining patients were closed with clips or purse-string sutures. The presence of an MP2-typetumor （P=0.018） and a wide connection with the MP layer （P=0.044） were significantly associated with perforation. Apreoperative evaluation of the integrity and the location of a tumor capsule and the length of the tumor connection withthe MP layer by EUS can improve the complete resection rate and reduce the occurrence of intraoperative complica-tions. Tumors with a complete capsule originating from the superficial