Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia

Figure 1 Endoscopic submucosal dissection. A: Endoscopic view of a submucosal tumor in the cardia of the stomach; B: Endoscopic ultrasonography showing a hypoechoic submucosal tumor in the muscularis propria; C: Circumferential markings around the lesion; D and E: Mucosal incision along the marked points after submucosal injection; F: The tumor was completely resected macroscopically; G: Resected specimen; H: Endoscopic view at the 3-month follow-up.

Figure 2 Submucosal tunneling endoscopic resection. A: Endoscopic view of the submucosal tumor in the cardia; B: Endoscopic ultrasound image showing a tumor originating from the muscularis propria; C: Incision 3-4 cm proximal to the tumor to create a submucosal tunnel after fluid cushion injection; D: Exposed tumor within the submucosal tunnel; E and F: Endoscopic dissection of the lesion through a tunnel; G: Tumor retrieval after en bloc resection; H: Endoscopic view at the 3-month follow-up.

Figure 3 Laparoscopic wedge resection. A: Endoscopic view of the submucosal tumor in the cardia; B: Endoscopic ultrasound image showing a tumor originating from the muscularis propria; C and D: Dissection of the anterior wall of the stomach to obtain an intragastric view with the submucosal tumor marked with clips; E and F: A laparoscopic linear stapler was used to perform wedge resection; G: Surgical suturing of the stomach; H: Endoscopic follow-up 6 months later showing no deformities.

Figure 4 Screening and analysis. LWR: Laparoscopic wedge resection; EGJ: Esophagogastric junction.

Figure 5 A patient who underwent laparoscopic wedge resection. A: A histology specimen from a patient who underwent a macroscopically complete resection during laparoscopic wedge resection, but with R1 resection in the final pathology report, showed no evidence of recurrence for > 5 years; B: Kaplan-Meier estimate of recurrence-free survival. ESD: Endoscopic submucosal dissection; STER: Submucosal tunneling endoscopic resection; LWR: Laparoscopic wedge resection.