Lin Huiting, Chen Songfeng, Tan Niandi, Zhuang Qianjun, Jia Xingyu, Jiang Dianxuan, Xiao Yinglian, Wang Jinhui
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.
Surg Endosc. 2025 Mar;39(3):1672-1680. doi: 10.1007/s00464-024-11509-z. Epub 2025 Jan 10.
Submucosal tunneling endoscopic resection (STER) is considered an effective, safe and minimally invasive treatment for esophageal subepithelial lesions (SELs) with maximal dilameter less than 3.0 cm, yet its efficacy for lesions over 3.0 cm remains unclear. This study aimed to evaluate the application value of STER for SELs of varying sizes.
Consecutive patients with esophageal SELs who underwent STER were retrospectively enrolled from May 2017 to March 2024. Baseline characteristics, surgical information and prognosis were collected and compared among patients with SELs of different sizes, as defined by the maximal diameter of the postoperative specimen.
A total of 133 patients were included, among whom 69 with SELs < 3.0 cm, 31 with SELs between 3.0 and 5.0 cm, 33 with SELs ≥ 5.0 cm. 1 case with SELs ≥ 5.0 cm was converted to endoscopic submucosal dissection (ESD) due to the tumor's adhesion to the epithelial layer. Among those who completed the STER procedure, the en bloc resection rate was 100.0% for all three subgroups, and the recurrence and metastasis rates were 0.0%, demonstrating that STER is effective for SELs of all sizes. However, SELs ≥ 5.0 cm were associated with more adverse events, a higher number of difficult procedures, and more frequent intensive care unit (ICU) transfers (all p < 0.050).
STER is effective and safe for treating esophageal SELs. For lesions exceeding 5 cm, while still feasible, the procedure requires meticulous planning, advanced techniques and careful monitoring due to increased complexity and risks.
对于最大直径小于3.0 cm的食管上皮下病变（SELs），黏膜下隧道内镜切除术（STER）被认为是一种有效、安全且微创的治疗方法，但其对直径超过3.0 cm的病变的疗效仍不明确。本研究旨在评估STER对不同大小SELs的应用价值。
回顾性纳入2017年5月至2024年3月期间接受STER治疗的连续性食管SELs患者。收集并比较不同大小SELs患者（根据术后标本的最大直径定义）的基线特征、手术信息和预后。
共纳入133例患者，其中69例SELs＜3.0 cm，31例SELs在3.0至5.0 cm之间，33例SELs≥5.0 cm。1例SELs≥5.0 cm的患者因肿瘤与上皮层粘连而转为内镜黏膜下剥离术（ESD）。在完成STER手术的患者中，三个亚组的整块切除率均为100.0%，复发和转移率均为0.0%，表明STER对所有大小的SELs均有效。然而，SELs≥5.0 cm与更多不良事件、更高的困难手术数量以及更频繁的重症监护病房（ICU）转运相关（所有p＜0.050）。
STER治疗食管SELs有效且安全。对于超过5 cm的病变，虽然该手术仍然可行，但由于复杂性和风险增加，需要精心规划、先进技术和仔细监测。
