Expanding the role of endoscopic resection in esophageal gastrointestinal stromal tumors: Insights and challenges

While rare, esophageal gastrointestinal stromal tumors (GISTs) have higher malignant potential and are typically diagnosed at larger sizes compared to gastric GISTs. However, well-defined guidelines for their optimal management remain lacking. Most esophageal GISTs are surgically managed with enucleation, while esophagectomy is reserved for larger tumors. Recent advances in endoscopic techniques, such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection (ER), have allowed for endoscopic removal of submucosal esophageal lesions, including GISTs. Xu et al reported on the clinical and oncological outcomes of 32 patients with esophageal GISTs treated with ER. The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival. However, it primarily focused on small, incidentally detected GISTs, with 75% of cases classified as very low or low risk according to the National Institutes of Health criteria. The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus. In this editorial, we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches. We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.