Feyissa GD. Artificial intelligence applications in exposed endoscopic full-thickness resection vs thoracoscopic surgery for complex esophageal subepithelial lesions: Narrative review. Artif Intell Gastroenterol 2026; 7(2): 121906 [DOI: 10.35712/aig.121906]
Corresponding Author of This Article
Gemechu Dereje Feyissa, Assistant Professor, Department of Public Health, Faculty of Health Sciences, Rift Valley University, East Show Zone, Adama 1715, Oromīa, Ethiopia. gemechudereje80@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
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Artif Intell Gastroenterol. Aug 8, 2026; 7(2): 121906 Published online Aug 8, 2026. doi: 10.35712/aig.121906
Artificial intelligence applications in exposed endoscopic full-thickness resection vs thoracoscopic surgery for complex esophageal subepithelial lesions: Narrative review
Gemechu Dereje Feyissa
Gemechu Dereje Feyissa, Department of Public Health, Faculty of Health Sciences, Rift Valley University, Adama 1715, Oromīa, Ethiopia
Author contributions: Feyissa GD conceptualized the review, drafted and revised the manuscript, and approved the final version.
AI contribution statement: No AI tools used for conceptualization, synthesis, analysis, or original text. Perplexity AI used solely for final grammar/Language polishing (sentence restructuring, redundancy removal) without changing science. All AI-generated outputs were critically reviewed and revised by the authors.
Conflict-of-interest statement: Author declares that there is no conflict of interest.
Corresponding author: Gemechu Dereje Feyissa, Assistant Professor, Department of Public Health, Faculty of Health Sciences, Rift Valley University, East Show Zone, Adama 1715, Oromīa, Ethiopia. gemechudereje80@gmail.com
Received: April 7, 2026 Revised: May 14, 2026 Accepted: June 11, 2026 Published online: August 8, 2026 Processing time: 124 Days and 18.7 Hours
Abstract
Complex esophageal subepithelial lesions (SELs; ≥ 35 mm or cervical location) originating from the muscularis propria challenge standard submucosal tunneling endoscopic resection due to risks of tunnel collapse, perforation, and retrieval failure. Exposed endoscopic full-thickness resection (EFTR) and thoracoscopic surgery (TS) offer viable alternatives, yet their complexity supports artificial intelligence (AI) integration for lesion characterization, workflow recognition, anatomical guidance, and complication prediction. This narrative review synthesizes evidence to February 2026 using a three-tier framework: Direct (esophageal SEL-specific EFTR/TS), adjacent (esophageal/upper gastrointestinal endoscopy), and transferable (surgical/robotic AI). AI-enhanced endoscopic ultrasound improves SEL accuracy (89%-95%); real-time phase recognition achieves 92%; robotic systems aid TS planning. SEL-specific prospective trials remain essential.
