Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection

Endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) are nowadays both adopted by endoscopists to resect upper gastrointestinal submucosal tumors (SMTs) arising from muscularis propria. This study aimed to compare the efficacy and safety of these two techniques. Seventy-seven patients were included in this retrospective study, among them, 35 received ESE and 42 received STER. Main outcome measurements included complete resection rate, perforation rate, adverse events, and tumor recurrence. Subgroup analysis based on tumor size was also performed. In general, ESE and STER had similar complete resection rate (94.7 vs. 97.7 %), perforation rate (10.5 vs. 13.3 %), and incidence of postoperative air leakage symptoms (13.2 vs. 2.2 %). No tumor recurrence occurred in any group. Subgroup analysis revealed that for tumors < 10 mm, both techniques achieved satisfactory therapeutic effects (100 % complete resection, no adverse events); for tumors > 10 mm, perforation rate increased in both ESE and STER (16 vs. 18.2 %), yet incidence of air leakage symptoms was significantly low in STER (3 %) compared to it in ESE (20 %). For SMTs < 10 mm, both ESE and STER have satisfactory therapeutic results, it is not necessary to pursue a difficult procedure when a simple method is available. For SMTs > 10 mm, STER is a preferable choice in terms of preventing air leakage symptoms, especially, when perforation is likely to happen.