Aims
Endoscopic submucosal excavation (ESE) for large subepithelial lesions (SELs) at the esophagogastric junction (EGJ) often faces challenges of large mucosal defects and difficult wound closure. This study aimed to preliminarily investigate the efficacy and safety of a modified technique—top linear incision-modified ESE (TLI-ESE)—for treating large SELs in this specific location.
Methods
This multicenter retrospective study enrolled 7 consecutive patients with EGJ-SELs who underwent TLI-ESE between May 2024 and August 2025 at three tertiary centers. Inclusion criteria were lesions originating from the muscularis propria layer with a long diameter >2 cm. Primary outcomes were technical success rate, en bloc resection rate, and R0 resection rate. Secondary outcomes included procedure time, complication rate, and follow-up results.
Results
Seven patients (3 males, 4 females) with a mean age of 43.4 years were included. All lesions were successfully resected using TLI-ESE, achieving both a technical success rate and an en bloc resection rate of 100%. The median procedure time was 65 minutes (range: 27-90 minutes). Postoperative pathology confirmed all lesions as leiomyomas with negative horizontal and vertical margins, resulting in an R0 resection rate of 100%. No intraoperative bleeding or perforation occurred. Postoperatively, there were no instances of delayed bleeding, perforation, infection, or pneumothorax. During a median follow-up of 3-24 months, all patients recovered well, and endoscopic review showed no local recurrence.
Table 1. Baseline Characteristics and Treatment Outcomes of Patients Undergoing TLI-ESE for EGJ-SELs
|
Case No |
Geder |
Age (years) |
Lesion Size （cm） |
Procedure Time（min） |
En Bloc Resection |
RO Resection |
Pathological Result |
Follow-up (months) |
Postoperative Complications |
Recurrence or Metastasis |
|||
|
Bleeding |
Perforation |
Infection |
Pneumothorax |
||||||||||
|
1 |
M |
53 |
8 |
60 |
yes |
yes |
Leiomyoma |
3 |
no |
no |
no |
no |
no |
|
2 |
M |
54 |
2.4 |
70 |
yes |
yes |
Leiomyoma |
5 |
no |
no |
no |
no |
no |
|
3 |
F |
24 |
2 |
90 |
yes |
yes |
Leiomyoma |
12 |
no |
no |
no |
no |
no |
|
4 |
F |
36 |
3.5 |
60 |
yes |
yes |
Leiomyoma |
24 |
no |
no |
no |
no |
no |
|
5 |
F |
33 |
3 |
27 |
yes |
yes |
Leiomyoma |
4 |
no |
no |
no |
no |
no |
|
6 |
M |
33 |
3.2 |
70 |
yes |
yes |
Leiomyoma |
4 |
no |
no |
no |
no |
no |
|
7 |
F |
70 |
2.8 |
66 |
yes |
yes |
Leiomyoma |
3 |
no |
no |
no |
no |
no |
Conclusions
This preliminary study suggests that TLI-ESE is a technically feasible, safe, and effective treatment strategy for large SELs in the EGJ region, achieving high en bloc and R0 resection rates with a low complication profile. This technique offers a novel approach to addressing the challenge of post-resection wound closure for large lesions, although its long-term efficacy requires further validation through larger prospective studies.