Exposed endoscopic full-thickness resection vs thoracoscopic surgery for complex esophageal subepithelial lesions arising from the muscularis propria

Figure 1 Flowchart of patient inclusion and grouping. SEL-MP: Subepithelial lesion originating from muscularis propria; EFTR: Endoscopic full-thickness resection; TS: Thoracoscopic surgery; ESD: Endoscopic submucosal dissection; STER: Submucosal tunneling endoscopic resection.

Figure 2 Procedures of endoscopic full-thickness resection for a case with esophageal subepithelial lesion originating from muscularis propria. A: Endoscopic view of esophageal subepithelial lesion originating from muscularis propria; B: Marking dots placed on the surface of the lesion; C: Dissection of the lesion from the muscularis propria; D: Esophageal wall defect following lesion resection; E: Incomplete closure of the esophageal wall defect using metallic clips; F: Resected specimen.

Figure 3 Endoscopic techniques for defect closure. A: Incomplete closure of esophageal wall defect using metallic clips; B: Kissing suture technique for the esophageal wall defect using a nylon loop and metallic clips; C: Esophageal wall defect managed withe the placement of a fully-covered stent.