Performance of endoscopic submucosal dissection and submucosal tunneling endoscopic resection for esophageal submucosal tumors: A multicenter retrospective cohort study

Fotios Fousekis; Konstantinos Mpakogiannis; Stamatia Vogli; Maximilien Barret; Flavius-Stefan Marin; Shaimaa Elkholy; Mohamed El-Sherbiny; Karim Essam; Hany Haggag; Sukrit Sud; Arjun Koch; Shivam Khare; Rui Morais; João Santos-Antunes; Oleksandr Kiosov; Alberto Herreros de Tejada; Vladyslav Yakovenko; Mandarino Vito Francesco; Ernesto Fasulo; George Tribonias; Ahmed Altonbary; Federico Barbaro; Biswa Ranjan Patra; Hany Shehab; Georgios Mavrogenis

Authors Fotios Fousekis, Konstantinos Mpakogiannis, Stamatia Vogli, Maximilien Barret, Flavius-Stefan Marin, Shaimaa Elkholy, Mohamed El-Sherbiny, Karim Essam, Hany Haggag, Sukrit Sud, Arjun Koch, Shivam Khare, Rui Morais, João Santos-Antunes, Oleksandr Kiosov, Alberto Herreros de Tejada, Vladyslav Yakovenko, Mandarino Vito Francesco, Ernesto Fasulo, George Tribonias, Ahmed Altonbary, Federico Barbaro, Biswa Ranjan Patra, Hany Shehab, Georgios Mavrogenis.

Abstract

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.

Keywords Esophageal submucosal tumors, submucosal tunneling endoscopic resection, endoscopic submucosal dissection

Ann Gastroenterol 2025; 38 (6): 595-603