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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(11): E1491-E1496
DOI: 10.1055/a-1922-7890
Original article

Subepithelial tumors: How does endoscopic full-thickness resection & submucosal tunneling with endoscopic resection compare with laparoscopic endoscopic cooperative surgery?

Michel Kahaleh 
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Vicky Bhagat
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Peter Dellatore
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Amy Tyberg
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Avik Sarkar
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Haroon M. Shahid
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Iman Andalib
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Resheed Alkhiari
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Monica Gaidhane
1   Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
,
Prashant Kedia
2   Gastroenterology, Methodist Hospital, Dallas, Texas, United States
,
Jose Nieto
3   Borland-Groover Clinic, Jacksonville, Florida, United States
,
Nikhil A. Kumta
4   Gastroenterology, Mount Sinai Hospital, New York, New York, United States
,
Rebekah E. Dixon
4   Gastroenterology, Mount Sinai Hospital, New York, New York, United States
,
Habeeb Salameh
4   Gastroenterology, Mount Sinai Hospital, New York, New York, United States
,
Georgios Mavrogenis
5   Gastroenterology, Mytilene Hospital, Mytilene, Greece
,
Stefanos Bassioukas
6   Gastroenterology, Latpikin, Athens, Greece
,
Seiichiro Abe 
7   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Vitor N. Arentes
8   Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
,
Flavio H. Morita
9   Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
,
Paulo Sakai
9   Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
,
Eduardo G. de Moura 
9   Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
› Author Affiliations TRIAL REGISTRATION: Retrospective trial NCT05041608 at ClinicalTrials.gov (http://www.clinicaltrials.gov/)
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Abstract

Background and study aims Endoscopic techniques are rapidly emerging for resection of subepithelial tumors (SETs). Submucosal tunneling for endoscopic resection (STER), endoscopic full-thickness resection (EFTR) and laparoscopic endoscopic cooperative surgery (LECS) are current alternatives to open surgery. In this study, we aimed to compare the three endoscopic techniques.

Patients and methods Consecutive patients who underwent resection of a submucosal esophageal or gastric lesion at several tertiary care centers were included in a dedicated registry over 3 years. Demographics, size and location of resected lesion, histology of specimen, length of procedure, adverse events (AEs), duration of hospital stay, and follow-up data were collected.

Results Ninety-six patients were included (47.7 % male, mean age 62): STER n = 34, EFTR n = 34, LECS n = 280. The lesions included leiomyoma, gastrointestinal stromal tumors (GISTs) and other. The mean lesion size was 28 mm (STD 16, range 20–72 mm). The majority of lesions in the EFTR and laparoscopic-assisted resection group were GISTs. There was no significant difference in clear resection margins, post-procedure complication rates, recurrence rate and total follow-up duration between the groups. However, the LECS group had a procedure time at least 30 minutes longer than STER or EFTR (P < 0.01). Total hospital stay for the laparoscopic-assisted resection group was also longer when compared to STER (1.5) and EFTR (1.8) (P < 0.01).

Conclusions STER, EFTR, and laparoscopic-assisted resection are efficacious approaches for resection of SETs with similar R0 resection rates, complication rates, and AE rates. Laparoscopic assisted resection appears more time-consuming and is associated with a longer hospital stay.



Publication History

Received: 03 March 2021

Accepted after revision: 10 August 2022

Accepted Manuscript online:
11 August 2022

Article published online:
15 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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