Endoscopic treatment of submucosal lesions of the gastrointestinal tract

Fourteen of symptomatic submucosal lesions located in the esophagus (n = 4), stomach (n = 4), duodenum (n = 1) and colon (n = 5) were treated by means of endoscopy. Treatment selection criteria for tumours (n = 10) were presence of a pedunculated tumour, or presence of a sessile tumour with a base smaller than 2 cm which originated in the upper wall layers, as judged by the mobility of the lesion. All tumours but one were successfully and completely removed by snare cauterization. The failure was a gastric fibroma which was incompletely resected; bleeding ensued rendering emergency surgery necessary. Mucosal cysts in the esophagus and colon were treated by either snare polypectomy in the case of smaller lesions or drainage in the case of larger cysts. Follow-up for 5 to 12 months (mean 8.7 months) in the 13 cases treated by means of endoscopy alone did not reveal recurrence. These preliminary results show that endoscopic treatment of smaller and superficially originating submucosal tumours may be a feasible alternative to surgery, however meticulous patient selection is necessary to avoid major complications.