AN EXPERIENCE WITH ENDOSCOPIC THERAPY IN SUBMUCOSAL TUMOR

Abstract

With extension of application of high frequency polypectomy, reports op successful endoscopic resection of submucosal tumors have increased in number. However, differing from ordinary polypectomy, the use for polypectomy is associated with higher risk of bleeding or perforation, which has limitied its application. We studied on endoscopic treatment of submucosal tumors of the stomach. Since 1974 we have treated 44 cases by (1) resection at one procedure using high frequency snare or by (2) resection at two procedures by which submucosal tumors are resected partially using a high frequency snare and the residual tumors are treated utilizing foreign body excretion capacity and digesting property of gastric juice. Twenty-two cases were treated at one procedure and 20 cases at two procedures. In 2 cases a complete treatment could not be performed. The first case underwent an operation and the second case was placed under observation. Both cases were at the early stage of this series. Massive bleeding or perforation occurred in none of the cases. These favourable results were obtained by selected indication by use of submucosography which is a growth type assessing method for submucosal tumors developed by us and the topical infusion of pure ethanol as an endoscopic hemostatic method. Especially, in vivo fixation of residual tumorous tissue accelerates falling off of tumors, and prevents bleeding at the time of the tumor falling, with a great importance in safety and extension of the indication. There appears a possibility that among intragastric or mural dependent tumors which account for about 85% of submucosal tumors those up to about 6 cm in diameter can be safely treated endoscopically in the future.