Surgical Endoscopy (2018) 32:3364–3372
Comparison between submucosal tunneling endoscopic resection
and video-assisted thoracoscopic enucleation for esophageal
submucosal tumors originating from the muscularis propria layer:
a randomized controlled trial
· Chen Du
· Ying Gao
· Xiaotong Niu
· Yaqi Zhai
· Enqiang Linghu
· Yang Liu
· Bo Yang
· Zhenjuan Li
· Xiangdong Wang
· Ping Tang
Received: 11 September 2017 / Accepted: 11 January 2018 / Published online: 16 January 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background and aims Surgical resection is considered the ﬁrst treatment option for submucosal tumors (SMTs) originat-
ing from the muscularis propria layer while submucosal tunneling endoscopic resection (STER) is proved to be a safe and
eﬀective method for treating SMTs. This study aimed to compare video-assisted thoracoscopic enucleation (VATE) with
STER for treating esophageal SMTs.
Methods Sixty-six patients with small esophageal SMTs were prospectively randomized from July 2014 to December 2015.
After exclusion of 8 patients, 58 subjects scheduled for STER or VATE were enrolled. Clinicopathological, endoscopic, and
adverse events (AEs) data were collected and analyzed between STER and VATE.
Results Forty-six males and 12 females with a mean age of 46.1 ± 9.4 years were randomized to the STER (n = 30) and VATE
(n = 28) groups, respectively. Demographics and lesion features were similar between the two groups. Median procedure
time was shorter in the STER group than the VATE group (44.5 vs. 106.5 min, P < 0.001); cost was lower in the STER group
(4499.46 vs. 6137.32 USD, P = 0.010). Median decrease in hemoglobin levels post-procedure was − 1.6 g/L in the STER
group and 14.7 g/L after VATE (P = 0.001). Lower postoperative pain scores were found in the STER group compared with
the VATE group (2 vs. 4, P < 0.001). No recurrent or residual tumors were found in either group. En bloc resection rates,
complete resection rates, hospital times, and post-procedure AEs were similar between two groups. The en bloc resection rates
for SMTs < 20.0 mm were 100% in both groups while STER achieved only 71.4% en bloc resection rate for SMTs ≥ 20.0 mm.
Conclusion STER and VATE are comparably eﬀective for esophageal SMTs; however, STER is superior to VATE with
shorter operation time and decreased cost, and seems safer than VATE. STER is recommended for SMTs < 20.0 mm while
VATE is recommended for SMTs with a transverse diameter > 35.0 mm.
Clinical trail registration statement: This study is registered at http://www.chictr.org.cn/showproj.aspx?proj=4814. The
registration identiﬁcation number is ChiCTR-TRC-14004759. The registration date is April 30, 2014.
Keywords Submucosal tunneling endoscopic resection · Video-assisted thoracoscopic surgery · Submucosal tumor ·
Submucosal tumors (SMTs) are a class of protruding lesions
with a normal mucosa-covered surface. SMTs are uncom-
mon entities of the upper gastrointestinal tract, with an
estimated overall prevalence of 0.3% in past . However,
the detection rate of SMTs has become increasingly preva-
lent thanks to the development of imaging techniques .
SMTs are usually found incidentally without symptoms. The
majority of SMTs are benign, although some have malignant
and Other Interventional Techniques
Ningli Chai and Chen Du contributed equally to this work.
* Enqiang Linghu
Department of Gastroenterology and Hepatology, Chinese
PLA General Hospital, Fuxing Road 28. Haidian District,
Beijing, People’s Republic of China
Department of Thoracic Surgery, Chinese PLA General
Hospital, Beijing, People’s Republic of China