Endoscopic Full-thickness Resection Versus Submucosal Tunnel Endoscopic Resection for Treatment of Upper Gastrointestinal Lesions

Abstract

Gastrointestinal subepithelial tumors (SETs), including neoplastic and non-neoplastic lesions, often require resection when symptomatic or when they possess malignant potential. Endoscopic full-thickness resection (EFTR) and submucosal tunnel endoscopic resection (STER) are minimally invasive techniques used for resecting these lesions. This meta-analysis aims to compare the efficacy and safety of EFTR and STER in the treatment of upper gastrointestinal (GI) lesions. A systematic search was conducted in Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane databases up to August 2024. Studies comparing EFTR and STER for upper GI lesions were included. Outcomes assessed were en bloc resection rate, complete resection rate, procedure time, recurrence rate, hospital stay, perforation rate, bleeding, and follow-up duration. Data were pooled using a random-effects model, and statistical significance was set at P <0.05. Eight studies, including 725 patients, were included. EFTR showed a significantly higher en-bloc resection rate (OR=4.81, 95% CI=1.56-14.90, P =0.006) and complete resection rate (OR=3.58, 95% CI=1.19-10.76, P =0.02). Recurrence rates were lower with EFTR (OR=0.17, 95% CI=0.03-0.87, P =0.03). No significant differences were found between EFTR and STER in procedure time (MD=-6.50 min, P =0.06), perforation rate (OR=9.38, P =0.41), or bleeding rates (OR=0.72, P =0.20). EFTR was associated with a shorter hospital stay (MD=0.66 d, 95% CI=0.27-1.05). EFTR offers superior en-bloc and complete resection rates, and a lower recurrence rate compared with STER for upper GI lesions. Both techniques are comparable in terms of procedure time and adverse events, with EFTR offering shorter hospital stays. However, the choice between EFTR and STER should be guided by tumor characteristics (size and location), endoscopist experience, and institutional resources. Further multicenter randomized studies are needed to confirm these findings and address variability in perforation risk.