Digestive submucosal tumors are tumors that originate below the mucosal layer, the most superficial layer of the intestine, which is intact. When a tumor grows from the mucosa (the so-called polyps) it is generally easy to remove it using simple mucosectomy techniques. However, when a tumor arises in a submucosal layer, it is generally not possible to remove it in this way, and a surgical resection is required, in which part of the affected organ generally has to be removed. Most submucosal lesions are formed by muscle, nervous or neuroendocrine tissue (nerve cells that produce hormones), and are most common in the upper digestive tract. In the esophagus, the most common are leiomyomas, which are humors formed by smooth muscle, and in the stomach, Gist (stromal tumors).
Until very recently, tumors could not be removed endoscopically and required aggressive surgery to remove them. In the case of the esophagus, it was necessary to remove a part of the esophagus as well. And in the case of lesions located in the stomach, approximately one third of the stomach had to be resected to be able to remove them.
Nowadays we can perform endoscopic removal of lesions that require it, without the need to resect the organ where they are located, that is, eliminate only and exclusively the tumor while preserving the normal anatomy of the organism.
It is what we know as POET (Per oral endoscopic tumorectomy). The POET consists of making a small incision in the mucosa, about 2 cm, located about 5 cm before reaching the tumor, to subsequently create a tunnel in the submucosa between the mucosa and muscle layers. Subsequently, the tunnel extends until it reaches the tumor.
At this time, the myotomy, removal of the tumor and its separation from the rest of the structures are performed, but all within the tunnel, leaving the mucosa intact, which will later cover this cut. The tumor is removed through the small incision that we made at the beginning in the mucosa. The technique ends by suturing the entry hole to the mucosa with staples.
It is performed in the operating room and under orotracheal intubation and lasts approximately 90 minutes, with expected discharge in less than 48 hours. In the Unit, the POET technique is performed to eliminate digestive submucosal tumors, which is the least aggressive treatment for these tumors and is currently available in very few National centers and none in the private sector.
It is one of the new minimally aggressive tunneling and endoscopic surgery techniques.
