Endoscopic submucosal dissection for gastric adenomyoma: A rare entity of 15 cases among 571 patients with gastric submucosal eminence lesions

Abstract

Gastric adenomyoma (GA) is a kind of rare gastric submucosal eminence lesions. As the malignant transformation cannot be ruled out, surgery and laparoscopic resection are usually considered. The aim of this study is to evaluate the therapeutic effect and safety of endoscopic submucosal dissection (ESD) for GA.All of the patients with gastric submucosal eminence lesions who underwent ESD from June 2008 to June 2015 in General Hospital, Tianjin Medical University, China, were identified, and patients with GA, which was confirmed by pathological evaluation, were enrolled for further analysis.Among the 571 patients who received ESD, 15 cases with uncertain diagnosis before the procedure were finally confirmed as GA. The mean age of these 15 patients was 46.93 ± 15.56 years (range: 18-73). Most of the lesions were located in antrum (12/15 patients), with 2 in the body of stomach and 1 in cardia, respectively. The mean size of the lesions was 1.47 ± 0.67 cm (range: 0.4-3.0). According to the endoscopic ultrasonography, the lesions of 14 patients originated from submucosa and 1 originated from superficial muscularis, totally with mixed echoes changes. En bloc complete resection was achieved in all of the lesions. No perforation, intraoperative bleeding, delayed bleeding, and mortalities occurred. No recurrence or metastasis was found during 1 to 67 months.ESD appears to be a feasible, safe, and effective treatment for GA with clinical presentation of gastric submucosal eminence lesions.

Figure 1

Endoscopic features of gastric adenomyomas. (A) Endoscopic view of a gastric submucosal eminence lesion in the antrum, which was pathologically diagnosed as gastric adenomyoma. (B) Endoscopic ultrasonography showed that the lesion originated from submucosa.

Figure 2

Endoscopic submucosal dissection technique and pathological characteristics of gastric adenomyomas. (A) The adenomyoma borders were marked. (B) The mucosa was elevated by a mixture solution of glycerin fructose and methylene blue plus 1:10,000 epinephrine injection. (C) A circular incision was made into the mucosa around the lesion. (D) The adenomyoma was removed from the gastric wall. (E) The wound after adenomyoma resection. (F) The adenomyoma was completely removed. (G) Gastric adenomyoma was characteristically composed of hypertrophic smooth muscle bundles and glands/ducts, lined by columnar or cuboidal epithelia. (H) Endoscopic view of the wound after 2 months’ follow-up.