Comparison between cap-aspiration lumpectomy versus endoscopic submucosal dissection for the treatment of small gastric submucosal tumors: a prospective randomized controlled trial.

BACKGROUND

Small (≤ 10 mm) gastric submucosal tumors (SMTs) are common clinical findings. Endoscopic resection has emerged as a promising alternative which enables early resection, but data comparing various methods remain limited. We aimed to compare the safety and efficacy of cap-aspiration lumpectomy (CASL) and endoscopic submucosal dissection (ESD) for resection of small gastric SMTs.

METHODS

We conducted a single-center, prospective, randomized controlled, non-inferiority clinical trial. A total of 102 patients who were referred for treatment of small gastric SMTs were prospectively enrolled. They were randomly assigned in a 1:1 ratio to undergo CASL or ESD.

RESULTS

All 102 SMTs, with average tumor size 8.70 ± 0.15 mm, were successfully resected. Most of the SMTs were gastrointestinal stromal tumor (54.9%) and leiomyomas (36.3%). Both CASL and ESD achieved comparable rates of R0 resection (96.1%) and full-thickness resection (EFTR) (CASL 51.0% vs. ESD 45.1%). However, CASL demonstrated significant advantages, including shorter mean resection time (CASL: 12.43 ± 0.82 min vs. ESD: 22.20 ± 1.45 min), fewer endoclips used, reduced estimated blood loss, and lower procedural costs. No significant difference was observed in the perioperative complications, antibiotic usage, postoperative stay, and time to first liquid diet. Endoscopic follow-up after 3 months revealed no recurrence in both groups.

CONCLUSIONS

This study suggests that both CASL and ESD are safe and effective as primary treatment of small gastric SMTs. Comparing the two methods, CASL has the advantage of shorter operation time and lower operation cost. Further larger-scale studies are warranted to validate these findings.