Submucosal Tunneling Endoscopic Resection for Upper Gastrointestinal Subepithelial Lesions: A Systematic Review and Meta-Analysis.

AIM

Submucosal tunneling endoscopic resection (STER) is an advanced endoscopic technique used for the minimally invasive removal of subepithelial lesions of the gastrointestinal (GI) tract. The aim of this study was to evaluate the safety and efficacy of STER for upper gastrointestinal subepithelial lesions.

METHODS

A comprehensive search of major scholar databases (until December 15, 2023) was performed. Complete resection rate was considered the primary outcome. En bloc resection, operation duration, length of stay (LOS), local recurrence, and periprocedural complications were considered secondary outcomes. Random-effects (RE) and fixed-effects (FE) models were used to generate the outcome estimates.

RESULTS

A total of 37 studies and 3795 patients were included. Pooled proportion of complete resection was 99% (95% CI 98.4-99.6%, p < 0.001). En bloc resection was achieved at 87.7% of cases. Overall mean operation duration was 64.2 min, while mean LOS was estimated at 4.93 days. The local recurrence rate was 0.1%. The two most common complications associated with STER were subcutaneous emphysema (5.5%) and pneumothorax (3%).

CONCLUSION

STER is a highly feasible and safe treatment modality for upper GI subepithelial lesions.