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

doi:10.3748/wjg.v31.i23.106261

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Jun 21, 2025 (publication date) through Jun 20, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jun 21, 2025; 31(23): 106261
Published online Jun 21, 2025. doi: 10.3748/wjg.v31.i23.106261

Table 1 Baseline characteristics of the patients, n (%)

	ESD (n = 15)	STER (n = 10)	LWR (n = 25)	P value
Age, years, median (IQR)	53.0 (40.0-57.5)	43.0 (39.0-57.0)	56.0 (43.0-64.0)	0.347
Sex				0.618
Male	6 (40.0)	6 (60.0)	12 (48.0)
Female	9 (60.0)	4 (40.0)	13 (52.0)
Preoperative symptoms				0.252
None	12 (80.0)	8 (80.0)	24 (96.0)
Abdominal discomfort	2 (13.3)	2 (20.0)	0 (0.0)
Chest discomfort	1 (6.7)	0 (0.0)	1 (4.0)
Location				0.013
EGJ	1 (6.7)	4 (40.0)	1 (4.0)
Cardia, AW side	4 (26.7)	0 (0.0)	5 (20.0)
Cardia, PW side	6 (40.0)	6 (60.0)	17 (68.0)
Cardia, fundal side	4 (26.7)	0 (0.0)	2 (8.0)
Long diameter of tumor, mm, median (IQR)¹	18.0 (15.5-23.0)	21.0 (17.0-23.0)	30.0 (25.6-36.0)	< 0.001
Regularity²				0.885
Regular	9 (60.0)	5 (50.0)	14 (56.0)
Irregular	6 (40.0)	5 (50.0)	11 (44.0)
Echogenicity				0.113
Hypoechoic-homogenous	12 (80.0)	8 (80.0)	13 (52.0)
Hypoechoic-heterogeneous	3 (20.0)	2 (20.0)	12 (48.0)
Layer origin³				0.114
Inner muscle layer	15 (100.0)	10 (100.0)	21 (84.0)
Outer muscle layer	0 (0.0)	0 (0.0)	4 (16.0)
Tumor type
Intraluminal growing type	15 (100.0)	10 (100.0)	25 (100.0)	1.000

¹Long diameter measured by endoscopic ultrasonography.

²Regularity of tumor shape on endoscopic ultrasonography.

³All layers are of muscularis propria origin, categorized as either inner or outer.

ESD: Endoscopic submucosal dissection; STER: Submucosal tunneling endoscopic resection; LWR: Laparoscopic wedge resection; IQR: Interquartile range; EGJ: Esophagogastric junction; AW: Anterior wall; PW: Posterior wall.

Table 2 Peri-operative clinical outcomes, n (%)

	ESD (n = 15)	STER (n = 10)	LWR (n = 25)	P value
En bloc resection	15 (100.0)	10 (100.0)	25 (100.0)	1.000
Macroscopic complete resection¹	15 (100.0)	10 (100.0)	25 (100.0)	1.000
Microscopic complete resection²				0.021
R0 resection	13 (86.7)	6 (60.0)	24 (96)
R1 resection	2 (13.3)	4 (40.0)	1 (4.0)
Pathological diagnosis				< 0.001
Leiomyoma	10 (66.7)	9 (90.0)	8 (32.0)
GIST with low-risk³	3 (20.0)	0 (0.0)	0 (0.0)
GIST with intermediate to high-risk⁴	2 (13.3)	1 (10.0)	17 (68.0)
Total procedure time, minutes, median (IQR)	75.0 (65.0-100.0)	84.0 (73.0-92.0)	70.0 (55.0-80.0)	0.075
Hospital stay, days, median (IQR)	6.0 (5.0-7.0)	6.0 (6.0-9.0)	5.0 (4.0-6.0)	0.017
Fasting duration, days, median (IQR)	2.0 (2.0-5.0)	3.0 (3.0-4.0)	1.0 (1.0-1.0)	< 0.001
Long diameter of tumor in pathology, mm, median (IQR)	27.0 (15.5-35.0)	28.5 (25.0-45.0)	36.0 (27.0-45.0)	0.002
Complications
Delayed bleeding	2 (13.3)	0 (0.0)	1 (4.0)	0.325
Pneumoperitoneum⁵	2 (13.3)	0 (0.0)	1 (4.0)	0.325
Peritonitis	0 (0.0)	0 (0.0)	0 (0.0)	1.000

¹Macroscopic complete resection was defined as both lateral and basal margins appearing lesion-free during the procedure.

²R0 resection was defined as both lateral and basal margins being lesion-free.

³The size is less than 2 cm, and the mitotic count is less than 5 per 50 high-power fields.

⁴The size is 2 cm or larger, or the mitotic count is 5 or more per 50 high-power fields.

⁵Free air is visible on the X-ray image, and air is removed via needle aspiration.

ESD: Endoscopic submucosal dissection; STER: Submucosal tunneling endoscopic resection; LWR: Laparoscopic wedge resection; GIST: Gastrointestinal stromal tumor; IQR: Interquartile range.

Table 3 Postoperative clinical outcomes, n (%)

	ESD (n = 15)	STER (n = 10)	LWR (n = 25)	P value
Follow up period, median (IQR)	60.0 (26.5-66.5)	24.0 (13.0-38.0)	35.0 (21.0-60.0)	0.065
Tumor recurrence	0 (0.0)	0 (0.0)	1 (4.0)	0.600
Death	0 (0.0)	0 (0.0)	0 (0.0)	1.000

ESD: Endoscopic submucosal dissection; STER: Submucosal tunneling endoscopic resection; LWR: Laparoscopic wedge resection; IQR: Interquartile range.

Table 4 Association between significant complications and clinicopathological characteristics, n (%)

	Without significant complication, 45 (90.0)¹	With significant complication, 5 (10.0)¹	RR (95%CI)	P value
Age, years
< 65	37 (82.2)	5 (100.0)	1 (reference)
≥ 65	8 (17.8)	0 (0.0)	1.27 (0.55-2.95)
Sex				0.706
Male	22 (48.9)	2 (40.0)	1 (reference)
Female	23 (51.1)	3 (60.0)	0.94 (0.43-2.06)
Location				0.006
EGJ or non-fundal side on cardia	29 (64.4)	0 (0.0)	1 (reference)
Cardia, fundal side	16 (35.6)	5 (100.0)	1.13 (0.53-2.45)
Tumor size	32.0 (25.0-40.0)	34.0 (32.0-35.0)		0.637
< 30 mm	23 (51.1)	2 (40.0)	1 (reference)
≥ 30 mm	22 (48.9)	3 (60.0)	0.96 (0.46-2.00)
Shape				0.254
Regular	24 (53.3)	4 (80.0)	1 (reference)
Irregular	21 (46.7)	1 (20.0)	2.35 (1.15-4.83)
Muscularis propria layer				0.487
Superficial	41 (91.1)	5 (100.0)	1 (reference)
Deep	4 (8.9)	0 (0.0)	1.81 (0.87-3.78)
Histology				0.336
Leiomyoma or GIST with low risk²	26 (57.8)	4 (80.0)	1 (reference)
GIST with intermediate to high risk³	19 (42.2)	1 (20.0)	0.92 (0.43-1.97)
Procedure type				0.637
Endoscopic resection⁴	22 (48.9)	3 (60.0)	1 (reference)
LWR	23 (51.1)	2 (40.0)	1.07 (0.22-5.28)
Long procedure				< 0.001
< 100 minutes	41 (91.1)	1 (20.0)	1 (reference)
≥ 100 minutes	4 (8.9)	4 (80.0)	0.96 (0.46-2.00)

¹Significant complications included delayed bleeding and pneumoperitoneum requiring needle aspiration.

²Size of < 2 cm and mitotic count of < 5 per 50 high-power fields.

³Size of ≥ 2 cm or mitotic count of ≥ 5 per 50 high-power fields.

⁴Endoscopic resection included endoscopic submucosal dissection and submucosal tunneling endoscopic resection.

RR: Relative risk; CI: Confidence interval; EGJ: Esophagogastric junction; GIST: Gastrointestinal stromal tumor; LWR: Laparoscopic wedge resection.

Citation: Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH. Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia. World J Gastroenterol 2025; 31(23): 106261
URL: https://www.wjgnet.com/1007-9327/full/v31/i23/106261.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i23.106261