Comparison of endoscopic resection, laparoscopic resection, and laparoscopic endoscopic cooperative surgery in esophageal or gastric subepithelial lesions in a Thai medical school

Esophageal and gastric subepithelial lesions (SELs) are increasingly identified in routine endoscopic evaluations, necessitating optimal resection strategies. Minimally invasive techniques, including endoscopic resection (ER), laparoscopic resection (LR), and laparoscopic-endoscopic cooperative surgery (LECS), have distinct advantages. The present study compares the outcomes of these techniques. To compare the clinical outcomes of ER, LR, and LECS in the management of esophageal or gastric SELs at King Chulalongkorn Memorial Hospital. A retrospective review was conducted on patients undergoing ER, LR, or LECS for esophageal and gastric SELs from January 2012 to August 2022. The primary outcome was the complete resection rate. Secondary outcomes included success rates, complications, and length of hospital stay. Statistical significance was set at P < 0.05. Among 42 patients, 11 (26.2%) underwent ER, 12 (28.6%) underwent LR, and 19 (45.2%) underwent LECS. Complete resection was significantly higher in LR (100%) and LECS (84.2%) than ER (45.5%) (P = 0.033). Delayed bleeding occurred in 18.2% of ER cases (P = 0.052). Hospital stay was shortest in ER (3.9 d) and longest in LR (9.3 d) (P = 0.877). While all techniques had high success rates, ER had the lowest complete resection rate and the highest bleeding risk. LR ensured complete resection but required longer hospitalization. LECS provided a balance between oncologic efficacy and safety. Surgical planning should be tailored based on tumor characteristics and surgical expertise.