Background and study aims: Submucosal tunneling endoscopic resection (STER) has become a potential option for
the endoscopic treatment of a selected group of patients with submucosal tumors (SMTs)
originating from the muscularis propria layer in the upper gastrointestinal tract.
The aim of this retrospective study was to analyze the incidence and management of
STER-related complications.
Patients and methods: From January 2011 to August 2013, 290 patients with upper gastrointestinal SMTs treated
by STER were included in the study. Clinicopathological characteristics and complication
data were collected and analyzed retrospectively.
Results: Mucosal injury occurred in three cases (1.0 %) and major bleeding occurred in five
cases (1.7 %). The gas-related complications were very common; however, only nine
cases of major pneumothorax (> 30 % lung collapse) needed therapeutic intervention
(3.1 %). Thoracic effusion occurred in 49 patients, 11 of whom had low grade fever
or segmental atelectasis that required thoracentesis and drainage (3.8 %). Thus, although
the overall incidence of complications was 23.4 % (68/290), only 10.0 % of procedures
(29/290) required intervention for complications. Based on the statistical analysis,
irregular shape, tumor in the deep muscularis propria layer, long procedure time,
and air insufflation were risk factors of STER-related major complications.
Conclusion: Although the incidence of STER-related complications was relatively high, most of
these complications were minor and did not require therapeutic intervention. STER
is a safe technique for the treatment of upper gastrointestinal SMTs.
