World Congress at ACG2017

Simultaneous Plenary Session 4B: Esophagus / Colon

72 - Comparison Between Submucosal Tunneling Endoscopic Resection and Video-Assisted Thoracoscopic Enucleation for Esophageal Submucosal Tumors Originating From the Muscularis Propria Layer: A Randomized Controlled Trial

Wednesday, October 18
10:00 AM - 10:10 AM
Location: Valencia Ballroom D (Level 4)



Category: Esophagus       

Chen Du, MS, Ningli Chai, MD, PhD, Ying Gao, MM, Xiaotong Niu, MM, Yaqi Zhai, MM, Enqiang Linghu, MD, PhD, Yang Liu, MD, PhD, Bo Yang, MD, Zhongsheng Lu, MD, Xiangdong Wang, MB, Ping Tang, MB
Chinese PLA General Hospital, Beijing, China (People's Republic)
Introduction: Surgical resection is considered the first treatment choice for submucosal tumors (SMTs) that originate from the muscularis propria (MP) layer while submucosal tunneling endoscopic resection (STER) is proved to be a safe and effective method for treating SMTs. This study aimed to compare video-assisted thoracoscopic enucleation (VATE) with STER for treating esophageal SMTs.

Methods: Sixty-six patients with small esophageal SMTs were prospectively randomized from July 2014 to December 2015. After 8 excluded, 58 undergoing either STER or VATE were enrolled. Clinicopathological, endoscopic, and adverse events (AEs) data were collected and analyzed between STER and VATE.

Results: Forty-six males and 12 females with a mean age of 46.1±9.4 years were randomized to the STER (n=30) or VATE (n=28) groups. Demographics and lesion features were similar in both groups. Median procedure time was shorter in the STER group than the VATE group (44.5 vs. 106.5 min, P=0.000); cost was lower in the STER group (4499.46 vs. 6137.32 USD, P=0.010). Median decrease in hemoglobin levels post-procedure was -1.6 g/L in the STER group and 14.7 g/L after VATE (P=0.001). Lower postoperative pain scores were found in the STER group compared with the VATE group (2 vs. 4, P=0.000). No recurrent or residual tumors were found in either group. En bloc resection rates, complete resection rates, hospital times, and post-procedure AEs were similar in both groups.

Discussion: STER and VATE are comparably effective for esophageal SMTs; however STER is superior to VATE with shorter operation time and decreased cost. STER seems safer than VATE with relatively reduced hemoglobin decrease and milder postoperative pain.

Supported by Industry Grant: No


Table 1. Effectiveness outcomes in the STER and VATE groups





































































Outcomes STER (n=30) VAST (n=28) P-value
En bloc resection, n (%) 26 (83.3) 28 (100%) 0.138
  < 20.0 mm 16 (100) 16 (100) 1.000
  ≥ 20.0 mm 10 (71.4) 12 (100) 0.10
Complete resection, n (%) 26 (83.3) 28 (100%) 0.138
Recurrence, n (%) 0 (0) 0 (0) /
Residual, n (%) 0 (0) 0(0) /
Operation time, medium (range), min 44.5 (15-130) 106.5 (55-263) 0.000
Hospital time, medium (range), day 7 (5-16) 7 (3-16) 0.490
Cost, medium (range), USD 4499.46 (2928.55-6915.12) 6137.32 (2930.75-148514.47) 0.010
Number of operator, medium (range)  2 (2-3) 5 (2-6) 0.000

STER,submucosal tunneling endoscopic resection; VATE, video-assisted thoracoscopic enucleation.


Table 2. Safety outcomes in the STER and VATE groups .




































































Adverse events STER (n=30) VAST (n=28)
 Subcutaneous or mediastinal emphysema 3 0
 Moderate fever 1 9
 Severe chest pain 0 1
 Pneumothorax, moderate fever and moderate fever 1 0
 Moderate fever, severe chest pain and ventricular fibrillation 0 1
Total AEs, n (%) 5 (16.7%) 5 (16.7%)
Postoperative pain score    
0 3 0
1-3 25 1
4-6 2 25
7-10 0 2
Medium Score 2 4

STER, submucosal tunneling endoscopic resection; VATE, video-assisted thoracoscopic enucleation; AEs, adverse events.


Figure 1. Study flowchart.

Citation: . COMPARISON BETWEEN SUBMUCOSAL TUNNELING ENDOSCOPIC RESECTION AND VIDEO-ASSISTED THORACOSCOPIC ENUCLEATION FOR ESOPHAGEAL SUBMUCOSAL TUMORS ORIGINATING FROM THE MUSCULARIS PROPRIA LAYER: A RANDOMIZED CONTROLLED TRIAL. Program No. 72. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Enqiang Linghu

Department of Gastroenterology & Hepatology
Chinese PLA General Hospital
Beijing, Beijing, China (People's Republic)

Dr. Enqiang Linghu is the Director of the Department of GI and Hepatology and Endoscopic Center of Chinese PLA General Hospital. He is the President-elect of the Chinese Society of Digestive Endoscopy and the Director of its branch study group for diagnosis and treatment of digestive varices. Dr. Linghu is the President of the Digestive Endoscopy Innovation and Development Branch of the Chinese Association for the Medical Device Industry and the President-elect of the Beijing Society of Digestive Endoscopy. He also serves as the Vice President of the Endoscopy Branch of the Chinese Medical Doctor Association, and is the Head of the Stomach Cancer Group of the WEO’s Upper GI Cancer Committee. Dr. Linghu is the Chief Editor of the Chinese Journal of Gastrointestinal Endoscopy and the Deputy Editor in Chief of the Chinese Journal of Digestive Endoscopy. He is an International Member of American Digestive Endoscopy, and member of the GIE Editorial Board. His scientific achievements include the 81th American ACG International Award, First Prize for the 2016 Military Science and Technology Progress Award, First Prize for the 2015 Beijing Medical Award, 78th American ACG International Award, and First Prize for the 2013 Military Medical Award. Dr. Linghu was awarded the 2016 First Class Award for Science and Technological Advancement of CMC.

Presentation(s):

Send Email for Enqiang Linghu


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72 - Comparison Between Submucosal Tunneling Endoscopic Resection and Video-Assisted Thoracoscopic Enucleation for Esophageal Submucosal Tumors Originating From the Muscularis Propria Layer: A Randomized Controlled Trial



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