Advancements in endoscopic resection of gastrointestinal stromal tumors: Techniques, outcomes, and perspectives

Table 1 Comparative summary of endoscopic resection techniques for gastrointestinal stromal tumors

Technique	Indications	Contraindications	Key advantages	Common complications	Technical complexity	Typical complete resection rate
ESD	Small, intraluminal GISTs ≤ 2-3 cm confined to mucosa/submucosa; favorable gastric locations	Deep muscularis invasion; poor lifting sign; proximity to large vessels	En bloc resection; tissue preservation	Bleeding (up to 15%), perforation (1%-8%)	High	Approximately 90%-95%
ESE	Intramural GISTs with muscularis propria origin; gastric cardia	Large extraluminal tumors; thin gastric walls	Deeper dissection capability	Bleeding (5%-18%), perforation (2%-10%)	Very high	Approximately 90%-95%
STER	Intramural tumors in esophagus or gastric cardia; ≤ 3.5 cm	Poor tunneling route; exophytic growth	Mucosal preservation; low leakage risk	Gas-related events (2%-6%), submucosal abscess	Very high	> 95%
EFTR	Deeply embedded or exophytic tumors; non-lifting lesions; tumors > 3-4 cm	Uncontrolled coagulopathy; failure of closure devices	Full-thickness access; suitable for complex cases	Intentional perforation; peritonitis (5%-8%), bleeding (up to 10%)	Very high	Approximately 90%-98% (in expert hands)

GISTs: Gastrointestinal stromal tumors; ESD: Endoscopic submucosal dissection; ESE: Endoscopic submucosal excavation; STER: Submucosal tunneling endoscopic resection; EFTR: Endoscopic full-thickness resection.