Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2025; 31(23): 106261
Published online Jun 21, 2025. doi: 10.3748/wjg.v31.i23.106261
Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia
Ah Young Lee, Sun Gyo Lim, Joo Young Cho, Seokhwi Kim, Kee Myung Lee, Sung Jae Shin, Choong-Kyun Noh, Gil Ho Lee, Hoon Hur, Sang-Uk Han, Sang-Yong Son, Jeong Ho Song
Ah Young Lee, Joo Young Cho, Department of Gastroenterology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul 06135, South Korea
Sun Gyo Lim, Kee Myung Lee, Sung Jae Shin, Choong-Kyun Noh, Gil Ho Lee, Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, South Korea
Seokhwi Kim, Department of Pathology, Ajou University School of Medicine, Suwon 16499, South Korea
Hoon Hur, Sang-Uk Han, Sang-Yong Son, Jeong Ho Song, Department of Surgery, Ajou University School of Medicine, Suwon 16499, South Korea
Author contributions: Lee AY contributed to data curation, formal analysis, and writing of the original draft of the manuscript; Lim SG contributed to conceptualization, visualization, supervision, writing-review, and editing; Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH contributed to methodology, investigation; Young J contributed to writing-review and editing; and all authors approved the final version of the manuscript for publication.
Institutional review board statement: All procedures were conducted in accordance with the ethical standards of the Hospital Ethics Committee and Institutional Review Board of Ajou University Hospital (approval No. AJOUIRB-DB-2024-311).
Informed consent statement: The need for written informed consent from the patients was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are not publicly available, as they are proprietary to the corresponding author; however, detailed summaries and analyses are provided within the article and its supplementary materials.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sun Gyo Lim, MD, PhD, Professor, Department of Gastroenterology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon 16499, South Korea. mdlsk75@ajou.ac.kr
Received: February 20, 2025
Revised: April 1, 2025
Accepted: May 30, 2025
Published online: June 21, 2025
Processing time: 120 Days and 10.7 Hours
Abstract
BACKGROUND

The spectrum of gastric submucosal tumors (SMTs) in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions, with gastrointestinal stromal tumors exhibiting inherent malignant potential. However, the diagnosis of SMTs remains challenging, and treatment methods, especially for tumors located at the cardia or esophagogastric junction (EGJ), are not well established. Minimally invasive techniques - such as endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER), and laparoscopic wedge resection (LWR) - have been developed for these lesions. However, comparative data on their feasibility, safety, and clinical outcomes in these locations remain limited.

AIM

To compare ESD, STER, and LWR for SMTs at the EGJ or cardia, focusing on procedural feasibility.

METHODS

This single-center retrospective study included patients with SMTs less than 45 mm from the muscularis propria, growing intraluminally at the EGJ or cardia, and treated with ESD, STER, or LWR between July 2014 and September 2022. The primary outcome was relapse-free survival during follow-up.

RESULTS

The median age (interquartile range) was 53.0 (40.0-57.5), 43.0 (39.0-57.0), and 56.0 (43.0-64.0) years for ESD, STER, and LWR, respectively. The median follow-up time (interquartile range) was 60.0 (26.5-66.5), 24.0 (13.0-38.0), and 35.0 (21.0-60.0) months. LWR had the largest tumors (30.0 mm) and the highest rate of high-risk gastrointestinal stromal tumors (68.0%, P < 0.001). Tumor recurrence occurred in one LWR patient (4.0%, P = 0.600). En bloc and macroscopic resection rates were 100% (P = 1.000), but microscopic resection rates differed (P = 0.021). Significant minor complications occurred in 5 patients (10.0%), all grade IIIa. Tumor location (cardia/fundus, P = 0.006) and prolonged procedure time (P < 0.001) were significantly associated with complications.

CONCLUSION

ESD, STER, and LWR are effective for SMTs at the EGJ and cardia, with minor complications associated with tumor location and procedure time, and comparable recurrence rates.

Keywords: Gastrointestinal stromal tumors; Muscularis propria; Cardia; Esophagogastric junction; Minimally invasive surgical procedures

Core Tip: This study compares endoscopic submucosal dissection, submucosal tunneling endoscopic resection, and laparoscopic wedge resection for submucosal tumors originating from the muscularis propria at the esophagogastric junction and cardia. Despite technical challenges, all methods demonstrated safety, practicality, and high en bloc resection rates, with laparoscopic wedge resection showing superior microscopic complete resection. Recurrence rates were comparable across methods, even for high-risk gastrointestinal stromal tumors. These findings underscore the feasibility of minimally invasive approaches for treating submucosal tumors in challenging anatomical locations, advancing diagnostic precision and treatment efficacy while minimizing patient burden.