A subepithelial lesion algorithm for endoscopic (SAFE) resection in the upper gastrointestinal tract.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Complete excision of upper gastrointestinal subepithelial lesions (U-SELs) is crucial for diagnosis and management.
• Current guidelines for U-SELs lack precision, and surgical options carry significant morbidity.
• An endoscopic resection algorithm (SAFE) was developed to address these limitations.

Purpose of the Study:

• To describe and report outcomes of the Structured Algorithm For Endoscopic (SAFE) resection for U-SELs.
• To evaluate the safety and efficacy of endoscopic resection techniques for U-SELs.
• To provide a framework for structured decision-making in managing U-SELs.

Main Methods:

• Prospective enrollment of U-SELs over 115 months.
• Pre-procedural imaging included computed tomography and endoscopic ultrasonography (EUS) to assess lesion characteristics and muscularis propria (MP) involvement.
• Specific endoscopic resection techniques (ESD, STER, e-EFTR) were employed based on lesion location and suspected depth.

Main Results:

• 106 U-SELs were resected in patients with a mean age of 60.6 years.
• High technical success rates were achieved: 97.6% for esophageal and 92.3% for gastric U-SELs.
• No delayed bleeding, perforation, or recurrence was observed at 13 months; some gastric cases required laparoscopic assistance or retrieval.

Conclusions:

• Endoscopic resection is an effective and safe treatment modality for U-SELs.
• The SAFE approach facilitates structured decision-making for U-SEL management.
• Specific endoscopic techniques (STER for esophageal, ESD/e-EFTR for gastric) are recommended, with consideration for laparoscopic assistance.