PARProceedings of Anticancer Research2208-35452208-3553Bio-Byword Scientific Publishing Pty. Ltd.10.26689/par.v8i6.8917ArticleCurrent Status and Considerations on Endoscopic Diagnosis and Treatment of Subepithelial Microlesions in the Digestive Tracthttps://artdesignp.com/journal/PAR/8/6/10.26689/par.v8i6.8917PangJian,TianYongjing,WuJingyu,SunChen,JiangYan,LeiXinwen,WangTengqi2024862024-11-25The detection rate of subepithelial lesions in the digestive tract, especially microlesions (≤ 1 cm in diameter), has significantly increased. Historically, periodic follow-up or surgical resection has been recommended by scholars. Due to the potential risk of malignancy, regular follow-up carries certain risks, while surgical resection, though effective, is highly invasive with a high risk of complications. With the rapid development of endoscopic techniques, more and more subepithelial lesions in the digestive tract have been successfully treated through endoscopic submucosal dissection and endoscopic full-thickness resection. However, these methods require a high level of skill and are associated with significant costs for surgical instruments and materials. Therefore, it is worth exploring whether a simpler and more efficient treatment can transition patients from observation to proactive treatment. A modified technique combining snare, long transparency cap, and Argon Plasma Coagulation under endoscopy has advantages over traditional methods, such as being simpler to perform, less prone to complications, and more cost-effective. This article reviews the current status and considerations of endoscopic treatment for subepithelial lesions in the digestive tract.

Yu L, Liang X, 2015, Interpretation of the Guidelines for the Diagnosis and Treatment of Gastrointestinal Stromal Tumors. Chinese Journal of Colorectal Disease (Electronic Edition), 4(1): 8–14.

Chen T, Zhou P, 2015, Advances in Minimally Invasive Surgical Treatment of Gastrointestinal Stromal Tumors. Chinese Journal of Digestive Endoscopy, 32(11): 782–784.

Zhou P, Zhong Y, Li Q, 2018, Expert Consensus on Endoscopic Diagnosis and Treatment of Gastrointestinal Submucosal Tumors in China (2018 Edition). Chinese Journal of Gastrointestinal Surgery, 21(8): 841–852.

Ning X, Liu Q, Guo W, et al., 2016, Evaluation of the Clinical Efficacy and Safety of Endoscopic Submucosal Dissection for Gastric Stromal Tumors. Heilongjiang Medicine, 29(4): 772–775.

Song F, Tan S, 2019, Characteristics of Endoscopic Ultrasound and Pathological Expression in Gastric Stromal Tumors with Different Invasive Risks. Journal of Gastroenterology and Hepatology, 28(6): 654–659.

Su L, Wang W, Pan H, et al., 2008, Endoscopic Resection of Esophageal Submucosal Tumors. China Tropical Medicine, 2008(9): 1531–1535.

Linghu E, 2010, Advances in Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). China Continuing Medical Education, 2(6): 31–34.

Gotoda T, Yamamoto H, Soetikno RM, 2006, Endoscopic Submucosal Dissection of Early Gastric Cancer. J Gastroenterol, 41(10): 929–942. https://doi.org/10.1007/s00535-006-1954-3

Kim SH, Moon JS, Youn YH, et al., 2011, Management of the Complications of Endoscopic Submucosal Dissection. World J Gastroenterol, 17(31): 3575–3579. https://doi.org/10.3748/wjg.v17.i31.3575

Fujishiro M, Yahagi N, Nakamura M, et al., 2006, Successful Outcomes of A Novel Endoscopic Treatment for GI Tumors: Endoscopic Submucosal Dissection with A Mixture of High-Molecular-Weight Hyaluronic Acid, Glycerin, and Sugar. Gastrointest Endosc, 63(2): 243–249. https://doi.org/10.1016/j.gie.2005.08.002

Zhou P, Yao L, Xu M, et al., 2008, Endoscopic Submucosal Excavation for the Treatment of Gastrointestinal Submucosal Tumors. China Medical Device Information, 2008(10): 3–5 + 9.

Zhang X, Wen W, Fan Z, et al., 2011, Application of Endoscopic Submucosal Excavation in Submucosal Tumors. Chinese Journal of Minimally Invasive Surgery, 11(3): 237–239.

Zhou P, Yao L, Qin X, et al., 2009, Endoscopic Full-Thickness Resection of Gastric Submucosal Tumors Originating from the Muscularis Propria Layer Without Laparoscopic Assistance. Chinese Journal of Digestive Endoscopy, 2009(12): 621.

Kantsevoy SV, 2006, Endoscopic Full-Thickness Resection: New Minimally Invasive Therapeutic Alternative for GI-Tract Lesions. Gastrointest Endosc, 64(1): 90–91. https://doi.org/10.1016/j.gie.2006.02.013

Expert Consensus on the Diagnosis and Treatment of Gastrointestinal Stromal Tumors in China (2011 Edition), n.d., 2012. Chinese Journal of Gastrointestinal Surgery, 2012(3): 301–307.

Zhou Y, Song S, Chen P, et al., 2015, Clinical Comparison of Laparoscopic, Endoscopic, and Dual-Scope Combined Surgery for Gastric Stromal Tumors. Journal of Clinical Surgery, 23(10): 750–752.

Zhang Y, Mao XL, Zhou XB, et al., 2018, Long-Term Outcomes of Endoscopic Resection for Small (≤ 4.0 cm) Gastric Gastrointestinal Stromal Tumors Originating from the Muscularis Propria Layer. World J Gastroenterol, 24(27): 3030–3037. https://doi.org/10.3748/wjg.v24.i27.3030

Hu J, Zhao Y, Ren M, et al., 2018, The Comparison between Endoscopic Submucosal Dissection and Surgery in Gastric Cancer: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract, 2018: 4378945. https://doi.org/10.1155/2018/4378945

Sun S, Wang M, Sun S, 2002, Use of Endoscopic Ultrasound-Guided Injection in Endoscopic Resection of Solid Submucosal Tumors. Endoscopy, 34(1): 82–85. https://doi.org/10.1055/s-2002-19386

Sun S, Wang Z, Xia Y, et al., 2003, Application of Endoscopic Ligation in the Treatment of Small Upper Gastrointestinal Leiomyomas. Chinese Journal of Digestive Endoscopy, 2003(2): 16–18.

Cheng Z, Ban X, 2015, Clinical Observation of 40 Cases of Gastric Stromal Tumors Treated with Endoscopic Ligation and Successful Specimen Retrieval. Chinese Community Doctors, 31(2): 32–33.

Lu F, Shen M, Zhang S, 2017, Clinical Analysis of Endoscopic Submucosal Dissection for the Treatment of Gastric Stromal Tumors. International Journal of Digestive Diseases, 37(4): 255–258.