Endoscopic resection of oesophageal gastrointestinal stromal tumours: Promise, pitfalls and the path forward

Table 1 Summary of different endoscopic resection techniques for submucosal lesions such as gastrointestinal stromal tumours

Endoscopic resection technique	Overview	Advantages	Limitations
ESD	Accurate resection of a lesion under direct endoscopic vision with closure using endoscopic clips	Achieves en bloc resection of large/flat lesions	Risk of full thickness perforation
ESSD	Modification of ESD - dissection down to deeper muscle layers	Removal of lesions in muscularis propria (deeper than traditional ESD)	Higher risk of perforation than traditional ESD
STER	Formation of “submucosal tunnel” proximal to a deeper lesion before resecting/closing the tunnel with clips	Reduced risk of leak/stricture/gas related complications	Size constraints of tunnel - lesions < 4 cm only. Tunnel related complications - bleeding/infection/delayed perforation
EFTR	Full thickness resection of a lesion either tunnelled/non tunnelled	Can tackle deeper/more invasive lesions not amenable to ESD without need for formal resection surgery	Requires closure every time/more advanced equipment and skills. Risk of perforation/Leak from closure. Can be combined with laparoscopy to assist in closure if required and in the stomach or gastro-esophageal junction

ESD: Endoscopic submucosal dissection; ESSD: Endoscopic subserosal dissection; STER: Submucosal tunnelling endoscopic resection; EFTR: Endoscopic full thickness resection.