Annals of gastroenterology · 2025
Performance of endoscopic submucosal dissection and submucosal tunneling endoscopic resection for esophageal submucosal tumors: A multicenter retrospective cohort study.
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Fousekis Fotios, Mpakogiannis Konstantinos, Vogli Stamatia, Barret Maximilien, Marin Flavius-Stefan, Elkholy Shaimaa, El-Sherbiny Mohamed, Essam Karim, Haggag Hany, Sud Sukrit, Koch Arjun, Khare Shivam, Morais Rui, Santos-Antunes João, Kiosov Oleksandr, de Tejada Alberto Herreros, Yakovenko Vladyslav, Francesco Mandarino Vito, Fasulo Ernesto, Tribonias George, Altonbary Ahmed, Barbaro Federico, Patra Biswa Ranjan, Shehab Hany, Mavrogenis Georgios
Аннотация
BACKGROUND: Esophageal submucosal tumors (ESTs) were typically managed through surveillance, but there is now a shift towards endoscopic resection. Endoscopic submucosal dissection (ESD) and submucosal tumor endoscopic resection (STER) appear to be safe and effective treatment options; however, evidence from non-East Asian centers is limited.
METHODS: This retrospective multicenter study included 97 patients from 15 centers across 9 countries who underwent endoscopic resection of ESTs via ESD or STER. Demographics, tumor characteristics, procedural details, adverse events and follow-up outcomes were recorded and analyzed.
RESULTS: Of the 97 patients, 48 underwent ESD and 49 STER. Most lesions were located in the lower esophagus and originated from the muscularis propria. En bloc resection was achieved in 95% of cases, with no significant difference between techniques (STER: 92% vs. ESD: 98%, P=0.18). The most common histologic diagnosis was leiomyoma (52%), followed by granular cell tumors (22%) and gastrointestinal stromal tumors (6%). Adverse events were infrequent: 9 cases of perforation were recorded, with only 4 being unintentional and all managed endoscopically. Follow-up data revealed only 1 case of local recurrence in a patient with a 50 mm lesion treated by STER. Hospital stay was longer after STER than ESD (3 vs. 2 days, P<0.001).
CONCLUSIONS: ESD and STER are effective and safe for ESTs, with high en bloc resection rates, minimal adverse events and very low recurrence during short-term follow up. These findings support the broader adoption of advanced endoscopic resection, which is transforming the management of ESTs from surgical to endoscopic treatment.
METHODS: This retrospective multicenter study included 97 patients from 15 centers across 9 countries who underwent endoscopic resection of ESTs via ESD or STER. Demographics, tumor characteristics, procedural details, adverse events and follow-up outcomes were recorded and analyzed.
RESULTS: Of the 97 patients, 48 underwent ESD and 49 STER. Most lesions were located in the lower esophagus and originated from the muscularis propria. En bloc resection was achieved in 95% of cases, with no significant difference between techniques (STER: 92% vs. ESD: 98%, P=0.18). The most common histologic diagnosis was leiomyoma (52%), followed by granular cell tumors (22%) and gastrointestinal stromal tumors (6%). Adverse events were infrequent: 9 cases of perforation were recorded, with only 4 being unintentional and all managed endoscopically. Follow-up data revealed only 1 case of local recurrence in a patient with a 50 mm lesion treated by STER. Hospital stay was longer after STER than ESD (3 vs. 2 days, P<0.001).
CONCLUSIONS: ESD and STER are effective and safe for ESTs, with high en bloc resection rates, minimal adverse events and very low recurrence during short-term follow up. These findings support the broader adoption of advanced endoscopic resection, which is transforming the management of ESTs from surgical to endoscopic treatment.