**Submucosal Tunneling Endoscopic Resection (STER)** is a highly specialized and minimally invasive advanced endoscopic procedure used to remove specific types of tumors, known as **submucosal tumors (SMTs)**, that originate from the muscular layers of the esophagus and stomach. These tumors, such as GISTs (gastrointestinal stromal tumors), leiomyomas, or neuroendocrine tumors, are located beneath the inner lining (mucosa) of the digestive tract, making them challenging to remove with conventional endoscopic techniques. STER offers a precise and effective way to resect these lesions without open surgery.

What is STER?

Unlike traditional endoscopic procedures that work on the surface of the GI tract, STER involves creating a "tunnel" within the submucosal layer (the layer just beneath the inner lining). Dr. Neeraj Dhar carefully enters the submucosal space through a small incision in the mucosa, creates a tunnel, identifies the SMT within this tunnel, and then meticulously dissects and removes it from its origin in the muscularis propria layer. After the tumor is removed, the initial mucosal incision is closed, allowing for a complete and contained resection.

Why is STER Performed? (Indications)

STER is primarily indicated for the removal of certain submucosal tumors in the esophagus and stomach:

• **Gastrointestinal Stromal Tumors (GISTs):** Especially smaller GISTs, which have a malignant potential and often require complete removal for diagnosis and treatment.
• **Leiomyomas:** Benign muscular tumors that can cause symptoms or grow large.
• **Neuroendocrine Tumors (NETs):** When located in the muscularis propria layer.
• **Other Submucosal Lesions:** Where a precise, full-thickness biopsy or removal is required for diagnosis or symptom relief.
• **Symptoms:** SMTs can cause symptoms like dysphagia (difficulty swallowing), pain, bleeding, or obstruction.
• **Diagnostic Certainty:** To obtain a definitive histological diagnosis of the tumor, which is crucial for determining its nature (benign or malignant) and guiding further management.

Benefits of STER:

• **Minimally Invasive:** Avoids open abdominal surgery, leading to smaller incisions, less pain, and faster recovery.
• **Organ Preservation:** The procedure removes only the tumor, preserving the integrity of the surrounding esophageal or gastric wall.
• **High Success Rate:** Offers a high rate of complete resection for appropriate SMTs.
• **Reduced Complications:** Generally lower rates of complications compared to traditional surgical resection.

Preparation for the Procedure:

Thorough preparation is essential for a safe and successful STER:

• **Fasting:** You will need to fast for at least 6-8 hours before the procedure (no food or drink) to ensure your upper GI tract is empty.
• **Medication Review:** Inform Dr. Dhar about all your medications, especially blood thinners, as these may need to be stopped or adjusted to minimize bleeding risk.
• **Pre-procedure Evaluation:** A detailed evaluation, including conventional endoscopy and often Endoscopic Ultrasound (EUS), will be performed to precisely locate, measure, and characterize the SMT. This helps in planning the tunneling approach.
• **Arranging for a Ride:** Since general anesthesia is used, you must arrange for someone to drive you home after the procedure and stay with you for a day.

What to Expect During the Procedure:

• STER is performed under **general anesthesia**, meaning you will be completely asleep during the procedure.
• Dr. Dhar will insert a specialized endoscope equipped with advanced cutting and coagulation tools through your mouth to reach the target area in the esophagus or stomach.
• A small incision is made in the mucosa, and a tunnel is carefully created in the submucosal space, advancing towards the tumor.
• Once the tumor is exposed, it is meticulously dissected and removed.
• After the tumor is removed, the initial mucosal incision is closed using endoscopic clips or sutures to prevent any leakage and ensure proper healing.
• The resected tumor specimen is retrieved for pathological examination.
• The procedure can take 1-3 hours or more, depending on the size and location of the tumor.

Recovery and Post-Procedure Care:

• You will be monitored in a recovery unit for several hours and typically require a hospital stay of a few days for close observation.
• Initially, you will be kept on nil by mouth (no food or drink) for a period, followed by a gradual progression to liquids and then soft foods as tolerated.
• You may experience some mild chest or abdominal discomfort, which can be managed with pain medication.
• Monitoring for potential complications like bleeding or perforation is crucial during the initial recovery phase.
• Detailed instructions will be provided regarding diet, activity restrictions, and follow-up appointments.

Why Choose Dr. Neeraj Dhar for STER?

Dr. Neeraj Dhar is an accomplished and highly skilled advanced endoscopist in Faridabad, with specialized expertise in complex interventional procedures like STER. Performing STER requires exceptional precision, advanced endoscopic skills, and a deep understanding of gastrointestinal anatomy and pathology. Dr. Dhar's extensive training and experience ensure that such intricate procedures are carried out with the highest level of safety and efficacy, leading to successful tumor removal and optimal patient outcomes. His commitment to utilizing the latest endoscopic techniques for minimally invasive treatment makes him a leading choice for patients requiring STER.

If you have been diagnosed with a submucosal tumor in your esophagus or stomach and STER has been recommended, consult Dr. Neeraj Dhar for a thorough evaluation and expert care in Faridabad.