Abstract: Objective To examine the feasibility and safety of gastric submucosal tunnel dissection of gastric submucosal tumors
(SMTs) by double tunnel and double flex endoscope. Methods Fifty patients with gastric SMTs detected by gastric endoscopy
and endoscopic ultrasonography between January, 2012 and August, 2013 were enrolled in this study. Using carbon dioxide
throughout the procedure, the mucous in the arc was incised along the margins of the lesion to separate the submucosa and
create a tunnel. The exposed SMTs were resected completely and the mucosa was covered by endoscopic forceps followed by
clipping of the incision. The complication, clinical outcomes, hospital stays and operation time were evaluated. Results Of the
50 lesions, 50 were located in the gastric fundus, 17 in the gastric antrum and 5 in the gastric body. The lesions were completely
resected in all the patients. The diameter of the resected lesions ranged from 0.5 to 2.5 cm (mean 1.1±0.6 cm), and the operation
lasted for 35.3 ± 16.2 min (range 23-76 min). In 5 cases (10%), perforation occurred during the operation and was closed by
clipping the incision with endoclips after the lesion resection; these patients were discharged after conservative management.
Intraoperative bleeding occurred in 16 cases and was successfully managed through endoscopic methods. No delayed
postoperative bleeding or perforation occurred in these patients. None of the 48 patients followed up showed tumor
recurrence at one year after the operation, and 2 patients were lost for follow up. Conclusion Endoscopic submucosal
dissection of gastric SMTs is effective and safe using double tunnel and double flex endoscope.