Clinical Outcomes of Endoscopic Full-Thickness Resection Versus Laparoscopic and Endoscopic Cooperative Surgery:...

Endoscopic full-thickness resection (EFTR) and laparoscopic and endoscopic cooperative surgery (LECS) are minimally invasive treatments for gastric submucosal tumors (SMTs). Because comparative data of both methods are lacking, we aimed to compare the clinical outcomes between EFTR and LECS for gastric SMT.

This multicenter study included patients who underwent EFTR or LECS for gastric SMT in four Japanese institutions. A 1:1 propensity score matching (PSM) analysis was performed with a caliper width of 0.2. Covariates included age; sex; body mass index; history of abdominal surgery, cardiovascular disease, or cerebrovascular disease; comorbidities; smoking and drinking habits; antiplatelet and anticoagulant intake; along with tumor location, type, and size.

We enrolled 38 patients treated with EFTR and 59, with LECS. After PSM, 21 patients were selected. The histological R0 resection rate was comparable between EFTR and LECS before (95% vs. 100%) and after (91% vs. 100%) PSM. In the EFTR group, median operation time was shorter (93 min vs. 161 min, p < 0.001), median numbers of attending doctors were fewer (5 vs. 3, p < 0.001), with procedure (¥305,330 vs. ¥434,700, p = 0.017) and total hospitalization costs (¥676,400 vs. ¥861,420) lower than those in the LECS group after PSM. Adverse event rates were low (5% vs. 14%, p = 0.606) in both groups.

EFTR and LECS provide efficacious oncological outcomes for patients with small (≤ 3 cm) intraluminal type gastric SMT. EFTR demonstrated favorable operative efficiency and economic outcomes, suggesting it may be a potentially cost-effective alternative.