Predictors for Achieving Textbook Outcomes After Endoscopic Resection of Giant Submucosal Tumors in the Esophagus and Cardia

Wei Su^#^{1

2}, Yun Wang^#^{1

2}, Haihan Xu^#³, Ji-Yuan Zhang^#^{1

2}, Xi-Guo Fang³, Hao Hu^{1

2}, Quan-Lin Li^{1

2}, Yun-Shi Zhong^{1

2}, Yi-Qun Zhang^{1

2}, Wei-Feng Chen^{1

2}, Ping-Hong Zhou^{4

5}, Sheng-Li Lin^{6

7}

Affiliations

¹ Zhongshan Hospital, Endoscopy Center and Endoscopy Research Institute, Fudan University, Shanghai, China.
² Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
³ Gastroenterology Department, People's Hospital of Yian Dinstrict, Tonglin, Anhui, China.
⁴ Zhongshan Hospital, Endoscopy Center and Endoscopy Research Institute, Fudan University, Shanghai, China. zhou.pinghong@zs-hospital.sh.cn.
⁵ Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China. zhou.pinghong@zs-hospital.sh.cn.
⁶ Zhongshan Hospital, Endoscopy Center and Endoscopy Research Institute, Fudan University, Shanghai, China. zshenrylsl@163.com.
⁷ Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China. zshenrylsl@163.com.

^# Contributed equally.

PMID: 40911126
DOI: 10.1007/s10620-025-09377-1

Predictors for Achieving Textbook Outcomes After Endoscopic Resection of Giant Submucosal Tumors in the Esophagus and Cardia

Wei Su et al. Dig Dis Sci. 2025.

. 2025 Sep 5.

doi: 10.1007/s10620-025-09377-1. Online ahead of print.

Authors

Affiliations

¹ Zhongshan Hospital, Endoscopy Center and Endoscopy Research Institute, Fudan University, Shanghai, China.
² Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
³ Gastroenterology Department, People's Hospital of Yian Dinstrict, Tonglin, Anhui, China.
⁴ Zhongshan Hospital, Endoscopy Center and Endoscopy Research Institute, Fudan University, Shanghai, China. zhou.pinghong@zs-hospital.sh.cn.
⁵ Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China. zhou.pinghong@zs-hospital.sh.cn.
⁶ Zhongshan Hospital, Endoscopy Center and Endoscopy Research Institute, Fudan University, Shanghai, China. zshenrylsl@163.com.
⁷ Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China. zshenrylsl@163.com.

^# Contributed equally.

PMID: 40911126
DOI: 10.1007/s10620-025-09377-1

Abstract

Background and aims: Endoscopic resection for submucosal tumors (SMTs) in the esophagus and cardia is challenging with hazards of adverse events and the exploration of its achieving textbook outcome (TO) was unknown. We aim to investigate the predictors of TO for giant SMTs with a long diameter ≥ 7 cm or a transverse diameter ≥ 3.5 cm.

Methods: A retrospective review was conducted for endoscopic resection of consecutive patients with giant SMTs in the esophagus and cardia between July 2017 and February 2022 at the Endoscopy center of Zhongshan Hospital, Fudan University. TO was mainly defined as absences of major adverse events, piecemeal resection, and prolonged hospital stay. Clinicopathologic, procedural characteristics, adverse events, and follow-up outcomes were analyzed.

Results: A total of 109 patients who completed endoscopic resection were analyzed. The median long and transverse diameter of the tumors were 7.5 cm (range, 4-15 cm) and 4 cm (range, 1.5-7 cm), respectively. The en bloc resection rate was 78.9%. Transverse diameter < 4.5 cm and regular shape were independent predictors for TO. Major adverse events (mAEs) occurred in 14 patients (12.8%). Long diameter ≥ 9 cm and piecemeal resection were significantly associated with mAEs. During a median follow-up of 33.5 months, there was no tumor recurrence or metastasis.

Conclusion: Giant esophageal or cardia SMTs with a long diameter < 9 cm and transverse diameter < 4.5 cm indicated a safe and credible outcome for endoscopic resection.

Keywords: Cardia; EFTR; Esophagus; Giant submucosal tumors; STER.

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Conflict of interest statement

Declarations. Conflict of interest: The authors disclose no conflicts of interest.

References

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Predictors for Achieving Textbook Outcomes After Endoscopic Resection of Giant Submucosal Tumors in the Esophagus and Cardia

Affiliations

Predictors for Achieving Textbook Outcomes After Endoscopic Resection of Giant Submucosal Tumors in the Esophagus and Cardia

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials