Endoscopic Resection Versus Laparoscopic Resection for Gastric Submucosal Tumors: A Systematic Review and Meta-Analysis of Safety and Efficacy

Introduction: Gastric submucosal tumors (G-SMTs) vary in malignancy risk, with surgical resection as standard treatment. Although extended endoscopic resection (eER) offers a less invasive option, its outcomes relative to laparoscopic resection (LR) remain unclear. This study evaluates the safety and efficacy of eER and LR. Materials and Methods: A systematic review and meta-analysis included articles comparing eER and LR for G-SMTs. The primary outcome was a complete resection rate. Results: 17 studies involving 1262 eER and 990 LR patients were included. LR showed a higher complete resection rate (RR 0.98, 95% CI 0.97-0.99, p < 0.01). eER favored operative time (95% CI -57.66 to -23.71, p < 0.01), blood loss (95% CI -63.46 to -17.45, p < 0.01), time to oral intake (95% CI -1.64 to -0.33, p < 0.01), and hospital stay (95% CI -1.75 to -0.13, p = 0.023). Subgroup analysis comparing endoscopic full-thickness resection (EFTR) to LR showed no significant difference in complete resection (RR 0.98, 95% CI 0.95-1.01, p = 0.18). Conclusions: LR may offer a higher complete resection rate, but eER demonstrated better short-term outcomes. EFTR achieved comparable resection rates to LR, supporting broader adoption with further technical refinement.