Closure strategies post-EMR for esophageal SMTs

Endoscopic mucosal resection (EMR) has become a widely adopted minimally invasive treatment for esophageal submucosal tumors (SMTs). Although prophylactic clip closure of the post-EMR wound is commonly performed to reduce complications, its clinical necessity and efficacy lack robust evidence. This study therefore aimed to compare the clinical outcomes of clip closure versus non-closure following EMR for esophageal SMTs.

This retrospective, single-center cohort study reviewed consecutive patients who underwent EMR for esophageal SMTs between January 2022 and November 2025. Based on post-EMR wound management, patients were allocated to a closure group (prophylactic metallic clip closure) and a non-closure group (observation only). Patient demographics, lesion characteristics, pathological diagnoses, and clinical outcomes including postoperative complications (bleeding, perforation), hospital stay, and costs were collected and analyzed.

A total of 84 patients (closure: n = 52; non-closure: n = 32) were included in the analysis. The two groups were well-balanced regarding baseline patient and lesion characteristics, with most tumors being small (≤ 10 mm), superficial (originating from the muscularis mucosae), and histologically confirmed as leiomyomas. The complication rate was minimal, with only one minor, conservatively managed bleeding event recorded in the closure group (1.9% vs. 0%; P = 1.0) and no perforations in either cohort. Similarly, no significant intergroup differences were observed for postoperative hospital stay (3.98 ± 1.18 vs. 4.47 ± 1.19 days; P = 0.07) or total hospitalization costs (9745.08 ± 3123.66 vs. 9180.34 ± 2647.80 yuan; P = 0.397).

For small esophageal SMTs (≤ 10 mm), prophylactic clip closure after EMR does not confer significant advantages over non-closure in reducing complications, hospital stay, or costs. Therefore, its routine use is not warranted.