Authors: Rayyan Fahad H. Altemani , Muflih Abdullah S. Albalawi , Yazeed Saeed M. Alqahtani , Yousef Ali H. Alaenzi , Sager Loaie H. Algorashi , Abdullah Majed H. Alruwaili , Abdulmohsen Mohmmed M. Alamri , Marwan Fahad H. Altemani , Mohammed Abdullah M. Albalawi

Abstract

Background: Esophageal submucosal tumors (SMTs), predominantly leiomyomas, are mostly benign but may
pose diagnostic and treatment challenges. Traditionally managed by surgery, minimally invasive approaches
like submucosal tunneling endoscopic resection (STER) and endoscopic submucosal dissection (ESD) now offer safer, less traumatic alternatives. This review compares their safety, efficacy, and outcomes for tumors from the esophageal muscularis propria (MP).

Methods: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching Medline, Cochrane, and Web of Science up to September 2025. Eligible English studies compared STER and ESD for esophageal SMTs from MP. Four reviewers extracted data, quality was assessed using the NIH tool, and Review Manager Software 5.3 conducted analyses with heterogeneity and bias assessments.a)

Results: This meta-analysis of three retrospective cohort studies (ESD n = 208, STER n = 201) found no significant difference in operating duration [MD = 2.89, 95%CI (-20.84, 26.62), p = 0.81]. STER was associated with shorter hospital stay [MD = -2.25, 95%CI (-2.37, -2.13), p < 0.00001] and lower complication risk [OR = 0.34, 95%CI (0.14, 0.78), p = 0.01].

Conclusion: ESD and STER show similar operating times; however, STER reduces hospital stay and complications, suggesting greater safety and efficiency, though larger, diverse studies are required to validate and guide clinical decisions.

Keywords: Esophageal submucosal tumors, Submucosal Tunnel Endoscopic Resection, endoscopic Mucosal Dissection