Predictors for Achieving Textbook outcomes after endoscopic resection of giant submucosal tumors in the esophagus and cardia

Background and Aims: Endoscopic resection for submucosal tumors (SMTs) in the esophagus and cardia is challenging with hazards of adverse events and the exploration of its achieving textbook outcome (TO) was unknown. We aim to investigate the predictors of TO for giant SMTs with a long diameter ≥ 7 cm, or a transverse diameter ≥ 3.5 cm. Methods A retrospective review was conducted for endoscopic resection of consecutive patients with giant SMTs in the esophagus and cardia between July 2017 and February 2022 at a tertiary referral center. TO was mainly defined as absences of major adverse events, piecemeal resection, and prolonged hospital stay. Clinicopathologic, procedural characteristics, adverse events, and follow-up outcomes were analyzed. Results A total of 109 patients who completed endoscopic resection were analyzed. The median long and transverse diameter of the tumors were 7.5 cm (range, 4–15 cm) and 4 cm (range, 1.5-7 cm), respectively. The en bloc resection rate was 78.9%. Transverse diameter < 4.5 cm and regular shape were independent predictors for TO. Major adverse events (mAEs) occurred in 14 patients (12.8%). Long diameter ≥ 9 cm and piecemeal resection were significantly associated with mAEs. During a median follow-up of 33.5 months, there was no tumor recurrence or metastasis. Conclusions Giant esophageal or cardia SMTs with a long diameter < 9 cm and transverse diameter < 4.5 cm indicated a safe and credible outcome for endoscopic resection.