Gel Immersion Endoscopic Mucosal Resection With Submucosal Injection for Superficial Esophageal Squamous Neoplasms (With Video)

IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY

DEN open Pub Date : 2026-10-07 DOI:10.1002/deo2.70444

Takahiro Uda, Yuji Urabe, Tomoyuki Gurita, Yoshiki Hatsushika, Satoshi Masuda, Yukiko Sako, Takeo Nakamura, Yuki Kamigaichi, Takeshi Takasago, Hidenori Tanaka, Akiyoshi Tsuboi, Ken Yamashita, Yuichi Hiyama, Yoshihiro Kishida, Hidehiko Takigawa, Akira Ishikawa, Toshio Kuwai, Shinji Mii, Shiro Oka

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Abstract

Objectives

Gel immersion can provide a stable immersion environment during endoscopic mucosal resection (EMR). However, its application in superficial esophageal squamous lesions remains limited. In this study, we evaluated a gel immersion EMR (GI-EMR) technique in which submucosal injection was intentionally performed before snaring for selected small superficial esophageal squamous lesions.

Methods

This single-center, retrospective case series included consecutive patients who underwent GI-EMR with submucosal injection for superficial esophageal squamous lesions ≤15 mm in size between January and March 2026. The primary outcome was the histological en bloc resection rate, while secondary outcomes included technical success, endoscopic en bloc resection rate, procedure time, adverse events, and histopathological findings.

Results

GI-EMR with submucosal injection was attempted for 13 lesions, achieving a technical success rate of 92% (12/13). One procedure was discontinued because adequate lifting could not be achieved due to post-chemoradiotherapy scarring. The endoscopic and histological en bloc resection rates were both 85% (11/13) on an intention-to-treat basis. The median procedure time was 4.25 min (range, 2.0–11.0 min). No intraoperative or delayed perforation, post-procedure bleeding, or gel-related adverse events occurred.

Conclusions

GI-EMR with submucosal injection was technically feasible for selected superficial esophageal squamous lesions ≤15 mm, with no serious procedure-related adverse events observed in this small case series.