Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH. Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia. World J Gastroenterol 2025; 31(23): 106261 [PMID: 40575341 DOI: 10.3748/wjg.v31.i23.106261]
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07768223
Submitted on:
August 08, 2025, 03:48
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Reader Comments:
This retrospective study aims to compare the feasibility, resection rates, and complications of endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) to laparoscopic wedge resection (LWR) in the treatment of subepithelial lesions (SELs) arising from the muscularis propria at the esophagogastric junction (EGJ) or gastric cardia. Lee et al. show that ESD, STER, and LWR are all feasible methods for resecting these lesions. Interestingly, the R0 resection rate is lower for ESD and especially STER when compared to LWR, however this may be related to the greater proportion of leiomyomas found in the ESD and STER groups, and leiomyomas are typically benign with very low chance for progression to malignancy. It is unclear if these lesions were sampled with EUS-guided fine needle biopsy prior to deciding on ESD, STER, or LWR, as achieving en bloc resection is more important for lesions with malignant potential such as GIST. Nevertheless this study shows that endoscopic resection methods such as ESD and STER are viable alternatives to surgical resection of SELs at the EGJ and gastric cardia. It is important for patients to have a complete pre-procedural workup including EUS, fine needle biopsy when possible, and CT chest and abdomen prior to embarking on resection.
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Reader's ID:
06484836
Submitted on:
June 21, 2025, 08:27
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4 Background
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6 Results
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Reader Comments:
The retrospective study on Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia by Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH is well conducted and written.
It very nicely describes the three techniques ESD, STER and LSW for lesions of the esophagus with excellent illustrations of all the three techniques with figures.
It paves the path for feasibility of further studies will large number of sample size.
Reply from the Editorial Office:
Thank you very much for your comments.
Reader's ID:
03721258
Submitted on:
June 20, 2025, 12:15
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Reader Comment Standards for Published Articles:
1 Title
Does the title reflect the main subject/hypothesis of the manuscript?
2 Abstract
Does the abstract summarize and reflect the work described in the manuscript?
3 Key Words
Do the key words reflect the focus of the manuscript?
4 Background
Does the manuscript adequately describe the background, present status and significance of the study?
5 Methods
Does the manuscript describe methods (e.g., experiments, data analysis, surveys, and clinical trials, etc.) in adequate detail?
6 Results
Are the research objectives achieved by the experiments used in this study?
Has the study made meaningful contributions towards research progress in this field?
7 Discussion
Does the manuscript interpret the findings adequately and appropriately, highlighting the key points concisely, clearly and logically?
Are the findings and their applicability/relevance to the literature stated in a clear and definite manner?
Is the Discussion accurate and does it discuss the paper’s scientific significance and/or relevance to clinical practice sufficiently?
8 Illustrations and Tables
Are the figures, diagrams and tables sufficient, good quality and appropriately illustrative of the paper contents?
Do figures require labeling with arrows, asterisks, etc., or better legends?
9 Biostatistics
Does the manuscript meet the requirements of biostatistics?
10 Units
Does the manuscript meet the requirements of use of SI units?
11 References
Does the manuscript appropriately cite the latest, important and authoritative references in the Introduction and Discussion sections?
Does the author self-cite, omit, incorrectly cite and/or over-cite references?
12 Quality of manuscript organization and presentation
Is the manuscript concisely and coherently organized and presented?
Are the style, language and grammar accurate and appropriate?
13 Ethics statements
For all manuscripts involving human studies and/or animal experiments, author(s) must submit the related formal ethics documents that were reviewed and approved by their local ethical review committee. Did the manuscript meet the requirements of ethics?
Scientific Quality:
The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories
Language Quality:
Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.
Reader Comments:
This study compares endoscopic submucosal dissection, submucosal tunneling endoscopic resection, and laparoscopic wedge resection for submucosal tumors originating from the muscularis propria at the esophagogastric junction and cardia. Despite technical challenges, all methods demonstrated safety, practicality, and high en bloc resection rates, with laparoscopic wedge resection showing superior microscopic complete resection. Recurrence rates were comparable across methods, even for high-risk gastrointestinal stromal tumors. These findings underscore the feasibility of minimally invasive approaches for treating submucosal tumors in challenging anatomical locations, advancing diagnostic precision and treatment efficacy while minimizing patient burden.
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Thank you very much for your comments.