Comparison between Submucosal Tunneling Endoscopic Resection and Endoscopic Submucosal Dissection for Prepyloric Submucosal Tumors: A Case-Matched Controlled Study.

Objectives: Endoscopic submucosal dissection (ESD) has become a well-established treatment method for gastric submucosal tumors (SMTs). However, there existed some challenges to perform ESD for prepyloric SMTs on account of the special location. Recently, submucosal tunneling endoscopic resection (STER) provided a novel option for prepyloric SMTs. This study aimed to make a comprehensive comparison between prepyloric STER (P-STER) and ESD for the treatment of prepyloric SMTs.

Methods: Patients with prepyloric SMTs undergoing P-STER treatment between January 2016 and October 2021 were retrospectively reviewed and individually matched at 1 : 1 ratio with those with ESD treatment according to lesion size, lesion location, pathologic diagnosis, lesion origin, and surgery date, forming P-STER and ESD group, respectively. A sample size of 12 patients was collected for each group. Treatment outcomes including resection time, en bloc resection rate, complete resection rate, and postoperative hospital stay as well as occurrence of complications were evaluated.

Results: Compared with ESD group, P-STER group got shorter resection time (52.50 minutes for ESD group vs. 38.67 minutes for P-STER group, P = 0.001), shorter postoperative hospital stay (7.00 day for ESD group vs. 5.50 day for P-STER group, P = 0.008), and lower rate of postoperative abdominal pain (50.00% for ESD group vs. 8.33% for P-STER group, P = 0.025). No complication was encountered in P-STER group, whereas one patient with postoperative bleeding was found in ESD group.

Conclusions: For the treatment of prepyloric SMTs, P-STER appeared to be a more effective endoscopic technique compared with ESD, although further randomized controlled trials were warranted.