Submucosal tunneling endoscopic resection in challenging esophageal subepithelial lesions: a minimally invasive approach

Background and Aims: Submucosal tunneling endoscopic resection (STER) is a minimally invasive procedure for resecting esophageal subepithelial lesions (SELs), particularly those arising from the muscularis propria layer. This article presents 2 challenging cases of esophageal SELs successfully managed with STER. Methods: Two esophageal SELs were managed with STER, which involved creating a submucosal tunnel for en bloc resection, followed by closure with hemostatic clips. Challenges related to lesion location, size, and patient comorbidities were addressed during the procedures. Results: Both patients underwent successful en bloc resection of the SELs without adverse events. One presented with progressive dysphagia for 2 years, and the other with dysphagia and intermittent chest pain. Both experienced significant clinical improvement postoperatively. Conclusions: STER offers an effective, minimally invasive alternative to surgery in challenging cases of esophageal SELs, demonstrating excellent results with reduced morbidity when performed with careful planning and multidisciplinary collaboration.