Ligation-assisted endoscopic mucosal resection versus endoscopic submucosal dissection for small gastrointestinal...

ObjectiveTo compare the clinical outcomes and hospitalization expenses of ligation-assisted endoscopic mucosal resection and endoscopic submucosal dissection for gastrointestinal deep-layer lesions measuring ≤1.0 cm.MethodsThis retrospective single-center cohort study included 486 patients with gastrointestinal deep-layer lesions detected using endoscopic ultrasonography. Eligible lesions measured ≤1.0 cm and were identified using endoscopic ultrasonography as originating from the muscularis mucosae, submucosa, or muscularis propria. Baseline characteristics and treatment outcomes were compared between the ligation-assisted endoscopic mucosal resection and endoscopic submucosal dissection groups before and after 1:1 propensity score matching. Multivariable ordinal logistic regression was performed to identify factors associated with hospitalization expense categories.ResultsAfter 1:1 propensity score matching, 336 patients were included in the matched cohort, with 168 patients in each group. No significant differences were observed in the en bloc resection rate, R0 resection status, incidence of procedure-related complications, duration of hemostatic drug use, and length of hospital stay between the ligation-assisted endoscopic mucosal resection and endoscopic submucosal dissection groups. Hospitalization expenses were significantly lower in the ligation-assisted endoscopic mucosal resection group than in the endoscopic submucosal dissection group after matching (renminbi 7900 (interquartile range, 6500-10,000) vs. 10,600 (interquartile range, 8700-13,200); p < 0.001). In adjusted ordinal logistic regression analyses, ligation-assisted endoscopic mucosal resection remained significantly associated with lower hospitalization expense categories in both primary adjusted model without actual length of hospital stay (adjusted odds ratio, 3.52; 95% confidence interval: 2.34-5.29; p < 0.001) and the sensitivity model further adjusted for actual length of hospital stay (adjusted odds ratio, 3.31; 95% confidence interval: 2.17-5.06; p < 0.001).ConclusionsLigation-assisted endoscopic mucosal resection was associated with comparable short-term clinical outcomes and lower observed hospitalization expenses compared with endoscopic submucosal dissection in selected patients with gastrointestinal deep-layer lesions measuring ≤1.0 cm. Prospective multicenter studies with long-term follow-up are needed to confirm these findings.