Comparison of Endoscopic Cap External Snare Resection (ECESR) and Endoscopic Muscularis Dissection (EMD) for Small Gastric Submucosal Tumors (≤ 12 mm) Emerging from the Muscularis propria

Nowadays, Endoscopic Muscularis Dissection (EMD) and Endoscopic Cap External Snare Resection (ECESR) are utilized as effective techniques for removing small submucosal tumors. Herein, We aimed to clarify the efficacy and outcomes of ECESR vs EMD to determine the optimal minimally invasive approaches for managing small (≤ 12 mm) Gastric Submucosal Tumors (sGSMT) arising from the muscularis propria (MP) layer.

This study retrospectively included data from patients who underwent ECESR or EMD to excise sGSMT of 12 mm or less. The propensity score matching (PSM) algorithm mitigated selection bias using age, gender, tumor size, location, and growth patterns for one-to-one matching. Finally, 96 patients were divided into ECESR (48) and EMD (48) groups. Clinicopathologic characteristics, procedural outcomes (procedure time, tumor resection time, and R0 resection), adverse events, length of hospital stay, and costs were compared between the two groups.

After PSM, the ECESR group experienced significantly shorter procedure time and tumor resection time (23 [21, 22] vs 47 [40–56] min; 5 [5, 6] vs 27 [26–30] min, P < 0.001). The ECESR group exhibited significantly shorter hospital stays (P < 0.001) and lower operation costs (P < 0.001) compared to the EMD group. Both groups achieved high rates of complete (R0) resection, with no statistically significant difference observed. Importantly, no recurrence or metastasis was observed in either group during follow-up. The incidence of adverse events, including perforation and postoperative complications, was comparable between groups, and no statistically significant differences were identified..

For sGSMT (≤ 12 mm), ECESR exhibits shorter procedure and tumor resection times, speedier recovery, lower operating costs, and shorter hospital stays compared to EMD.