Objective To explore the feasibility and safety of submucosal tunneling endoscopic resection (STER) for the treatment of giant (long diameter≥3.5 cm) symptomatic submucosal tumors (SMT) originating from the esophageal and cardiac muscularis propria layer.

Methods A retrospective analysis was conducted on patients with giant symptomatic SMT of the esophagus and cardia treated with STER at the Endoscopy Center of Zhongshan Hospital, Fudan University from January 2017 to January 2020. Clinical characteristics and follow-up data of patients were collected. The efficacy of STER was evaluated by complete resection rate, recurrence rate, and residual rate. The safety of the procedure was assessed by the occurrence of procedure-related complications.

Results A total of 111 patients with SMT were included, including 65 males and 46 females, with an average age of (43.2±11.6) years old. Among them, 11 patients (9.9%) presented with typical symptoms. Leiomyomas accounted for 105 cases, gastrointestinal stromal tumors for 2 cases, and schwannoma for 4 cases. The median long diameter of the tumors was 5 cm, and the median short diameter was 3 cm. The median operation time was 70 minutes, and the median time of hospital stay was 3 days. The success rate of STER was 100%, with a complete resection rate of 73.9%. Intraoperative mucosal injury was observed in 18 cases (16.2%), postoperative complications occurred in 16 cases (14.4%), including severe pneumothorax/pleural effusion requiring drainage in 10 cases (9.0%), delayed bleeding in 1 case (0.9%), moderate or severe fever in 4 cases (3.6%), and infection in tunnel in 1 case (0.9%). Follow-up at 1-18 months showed no tumor residue, recurrence, esophageal stenosis, diverticula or other long-term complications.

Conclusions STER is a safe and effective treatment for giant symptomatic SMT of the esophagus and cardia.