Comparison of endoscopic full-thickness resection and ligation-assisted endoscopic full-thickness resection for small (=1.5 cm) gastric subepithelial tumors originating from muscularis propria

Background In the treatment of small gastric subepithelial tumors originating from muscularis propria (SET-MPs), endoscopic full-thickness resection (EFTR) has been an effective procedure and ligation-assisted EFTR (EFTR-L) seems a feasible and promising operation. We aimed to compare the therapeutic outcomes of EFTR-L and EFTR to evaluate effect and safety of either method in the treatment of small (<= 1.5 cm) gastric SET-MPs.Methods Between January 2018 to May 2022, we retrospectively enrolled a total of 119 patients with gastric SET-MPs treated by EFTR-L (79 patients) or EFTR (40 patients) at Xiangya Hospital Central South University. Clinical characteristics, operation efficacy, adverse events (AEs), and operation cost were compared between the 2 groups. Univariate and multiple logistic and linear regressions were applied to analyze the therapeutic outcomes of the procedure, and covariates were adjusted in the multiple analysis.Results The operation time of EFTR-L group (16.34 +/- 5.75 min) was significantly shorter than EFTR group (51.23 +/- 21.21 min, P < 0.001), and the difference remained significant after adjusting the covariates (adjusted mean difference, 30.56; 95% confidence interval, 25.65-35.47; P < 0.001). The operation cost of EFTR-L group was lower than EFTR group (1268.52 +/- 457.22 vs 1643.18 +/- 295.08 $; P < 0.001). The complete resection rate of the EFTR-L group was 98.72% and of the EFTR group 100%. The incidence of abdominal pain in the EFTR-L group (5.06%) was lower than in the EFTR group (27.50%, P = 0.008). A patient in the EFTR group underwent severe pneumoperitoneum and received abdominocentesis during operation. One case of peritonitis occurred in the EFTR-L group but recovered from intensified antibiotic therapy. No delayed blood or perforation occurred.Conclusions Compared to EFTR, EFTR-L might be a feasible procedure for small (<= 1.5 cm) gastric SET-MPs due to the acceptable efficacy, shorter operation time, and lower cost.

Automated summary

The study compared the therapeutic outcomes of EFTR-L and EFTR in the treatment of small gastric subepithelial tumors (SET-MPs), and found that EFTR-L had shorter operation time and lower cost compared to EFTR. Both methods had similar complete resection rates, but the incidence of abdominal pain was lower in the EFTR-L group.