Published online May 14, 2026. doi: 10.3748/wjg.v32.i18.116018
Revised: December 4, 2025
Accepted: February 25, 2026
Published online: May 14, 2026
Processing time: 187 Days and 0.6 Hours
Tumor enucleation via thoracoscopic surgery (TS) and submucosal tunneling endoscopic resection are both effective and widely used therapies for resecting most esophageal subepithelial lesions (SELs) originating from the muscularis propria (MP). However, when a lesion exceeds 35 mm in diameter and/or is located in the cervical esophagus, it is classified as a complex esophageal tumor. In such cases, submucosal tunneling endoscopic resection is not feasible due to insufficient tunnel space and the inability to successfully extract the lesion from the tunnel. Exposed endoscopic full-thickness resection (EFTR), which does not require tunnel creation, is a potential alternative treatment for complex esopha
To compare the feasibility and safety of esophageal exposed EFTR with TS for the resection of complex esophageal SELs.
Between November 2016 and October 2023, the clinical records of patients with esophageal SELs-MP who underwent resection at the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed. Patients with lesions larger than 35 mm in diameter and/or located in the cervical esophagus were included in the study. Clinicopathological characteristics, perioperative outcomes, complications, and follow-up data were col
A total of 60 patients with complex esophageal SELs-MP were included, with 15 patients in the EFTR group and 45 in the TS group. The EFTR and TS groups demonstrated comparable technical success rates (100% vs 97.8%, P = 0.574) and en bloc resection rates (86.7% vs 75.6%, P = 0.423). Compared to the TS group, the EFTR group had a significantly longer median procedure time (240.0 minutes vs 120.0 minutes, P < 0.001) but a shorter postoperative nasogastric decompression period (5.6 ± 4.9 days vs 10.7 ± 13.2 days, P = 0.016). In the EFTR group, complete defect closure was achieved in 3 patients (20.0%), incomplete closure in 8 patients (53.3%), and non-closure in 4 patients (26.7%). Postoperative adverse events occurred in 3 patients in the EFTR group and 4 patients in the TS group. Both groups experienced cases of esophageal stricture and fistula. Notably, chylothorax was observed exclusively in the TS group.
Esophageal-exposed EFTR demonstrated clinical outcomes comparable to those of TS, suggesting that it is a safe and feasible option for the treatment of complex esophageal SEL-MP. Further studies are warranted to validate these findings.
Core Tip: Esophageal exposed endoscopic full-thickness resection (EFTR) proved to be a safe procedure for complex esophageal subepithelial lesions-muscularis propria. Postoperative adverse events were conservatively managed and occurred at an acceptable rate. Exposed EFTR achieved 100% technical success and curative resection. Even for large tumors requiring piecemeal resection for retrieval, patient outcomes were not compromised. Patients undergoing esophageal exposed EFTR demonstrated faster recovery, evidenced by earlier initiation of oral intake and shorter nasogastric intubation durations.