Predictors of difficult endoscopic resection of submucosal tumors originating from the muscularis propria layer at the esophagogastric junction

Table 1 Clinical characteristics and therapeutic outcomes of 90 patients with submucosal tumors originating from the muscularis propria layer in the esophagogastric junction

Variable	Number
Age, median (range), yr	55.5 (25.0–74.0)
Male/Female, n (%)	42/48 (46.7/53.3)
Location, n (%)
Esophagocardia	25 (27.8)
Cardia	26 (28.9)
Gastrocardia	39 (43.3)
Tumor diameter, median (range), mm	20.0 (5.0–100.0)
Shapes of lesion, n (%)
Regular	47 (52.2)
Irregular	43 (47.8)
Growth pattern, n (%)
Predominant extraluminal	17 (18.9)
Predominant intracavitary	73 (81.1)
Surface, n (%)
Smooth	77 (85.6)
Reddish and erosive	13 (14.4)
Surgical approach, n (%)
STER	44 (48.9)
EFTR	14 (15.6)
ESD	32 (35.5)
En bloc resection, n (%)	76 (84.4)
Operation time, median (range), min	43 (16–126)
Intraoperative bleeding, n (%)
Bleeding group	17 (18.9)
No bleeding group	73 (81.1)
Histopathology, n (%)
Leiomyoma	71 (78.9)
GIST	18 (20.0)
Schwannoma	1 (1.1)
Follow-up time, median (range), months	16.4 (6.0–26.0)

STER: Submucosal tunneling endoscopic resection; EFTR: Endoscopic full-thickness resection; ESD: Endoscopic submucosal dissection; GIST: Gastrointestinal stromal tumors.

Table 2 The characteristics of the lesions treated by various methods of endoscopic resection

Variable	STER	EFTR	ESD
Tumor diameter, n (%)
< 30 mm	23 (52.3)	10 (71.4)	23 (71.9)
≥ 30 mm	21 (47.7)	4 (28.6)	9 (28.1)
Location, n (%)
Esophagocardia	19 (43.2)	0 (0.0)	6 (18.8)
Cardia	18 (40.9)	2 (14.3)	6 (18.8)
Gastrocardia	7 (15.9)	12 (85.7)	20 (62.4)
Shapes of lesion, n (%)
Regular	16 (36.4)	11 (78.6)	20 (62.5)
Irregular	28 (63.6)	3 (21.4)	12 (37.5)
Growth pattern, n (%)
Predominant extraluminal	6 (13.6)	11 (78.6)	0 (0.0)
Predominant intracavitary	38 (86.4)	3 (21.4)	32 (100.0)
Histopathology, n (%)
Leiomyoma	42 (95.4)	4 (28.6)	25 (78.1)
GIST	1 (2.3)	10 (71.4)	7 (21.9)
Schwannoma	1 (2.3)	0 (0.00)	0 (0.0)
Operation time, median (range), min	50 (18–126)	55 (23–108)	36 (16–116)
En bloc resection, n (%)	34 (77.3)	13 (92.9)	29 (90.6)
Intraoperative bleeding, n (%)
Bleeding group	8 (18.2)	3 (21.4)	6 (18.8)
No bleeding group	36 (81.8)	11 (78.6)	26 (81.3)

STER: Submucosal tunneling endoscopic resection; EFTR: Endoscopic full-thickness resection; ESD: Endoscopic submucosal dissection; GIST: Gastrointestinal stromal tumors.

Table 3 Risk factors associated with piecemeal resection, long operative times (≥ 60 min) and bleeding during the procedure

Variable	En bloc resection and piecemeal resection		Operative times ≥ 60 min and < 60 min		Bleeding and no bleeding during the procedure
	Univariate analysis, OR (95%CI), P value	Multivariate analysis, OR (95%CI), P value	Univariate analysis, OR (95%CI), P value	Multivariate analysis, OR (95%CI), P value	Univariate analysis, OR (95%CI), P value	Multivariate analysis, OR (95%CI), P value
Age, (yr)
< 60	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
≥ 60	0.095 (0.012–0.763), 0.027	0.082 (0.007–0.929), 0.043	0.648 (0.260–1.614), 0.351	0.896 (0.172–4.677), 0.896	0.828 (0.276–2.485), 0.736	1.226 (0.234–6.419), 0.809
Sex, No.
Female	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
Male	1.171 (0.374–3.665), 0.786	1.807 (0.334–9.776), 0.492	1.111 (0.465–2.655), 0.813	1.089 (0.247–4.799), 0.911	0.760 (0.261–2.215), 0.615	1.101 (0.225–5.380), 0.906
Shape of lesion, No.
Regular shape	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
Irregular shape	19.933 (2.477–160.405), 0.005	18.004 (1.340–241.863), 0.029	9.491 (3.324–27.102), 0.000	6.863 (1.160–40.602), 0.034	12.054 (2.561–56.733), 0.002	19.020 (1.570–230.493), 0.021
Tumor diameter
< 30 mm	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
≥ 30 mm	14.7270 (3.043–71.279), 0.001	7.346 (1.191–45.323), 0.032	33.150 (9.855–111.510), 0.000	47.330 (8.411–266.322), 0.000	21.316 (4.456–101.977), 0.000	20.631 (3.066–138.803), 0.002
Surgical approach
STER	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
ESD	0.352 (0.088–1.401), 0.138	0.635 (0.088–4.572), 0.652	0.404 (0.144–1.134), 0.085	1.554 (0.217–11.120), 0.661	1.038 (0.321–3.354), 0.950	2.696 (0.372–19.537), 0.326
EFTR	0.262 (0.030–2.251), 0.222	1.596 (0.039–65.206), 0.805	1.083 (0.321–3.659), 0.897	7.233 (0.335–156.259), 0.207	1.227 (0.277–5.439), 0.787	37.935 (0.849–1694.936), 0.061
Location
Esophagocardia	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
Cardia	0.576 (0.141–2.349), 0.442	0.371 (0.059–2.342), 0.291	1.304 (0.422–4.027), 0.645	0.824 (0.132–5.134), 0.836	0.576 (0.141–2.349), 0.442	0.282 (0.045–1.772), 0.177
Gastrocardia	0.362 (0.091–1.443), 0.150	1.407 (0.115–17.261), 0.789	0.698 (0.239–2.044), 0.512	0.582 (0.051–6.572), 0.661	0.693 (0.203–2.368), 0.558	0.808 (0.055–11.832), 0.876
Growth pattern
Predominant intracavitary	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
Predominant extraluminal	0.288 (0.035–2.373), 0.248	0.272 (0.016–4.484), 0.362	1.932 (0.661–5.649), 0.229	5.522 (0.480–63.514), 0.170	0.516 (0.106–2.505), 0.411	0.086 (0.002–3.016), 0.176
Surface
Smooth	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
Reddish and erosive	1.800 (0.427–7.593), 0.424	0.707 (0.097–5.141), 0.732	1.783 (0.542–5.862), 0.341	1.315 (0.203–8.534), 0.774	2.188 (0.584–8.192), 0.245	2.059 (0.234–18.133), 0.515
Histopathology
Leiomyoma	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)	1 (reference)
GIST/Schwannoma	0.248 (0.030–2.027), 0.193	1.513 (0.072–31.658), 0.790	0.849 (0.288–2.508), 0.767	0.632 (0.055–7.297), 0.713	0.763 (0.195–2.988), 0.698	2.037 (0.122–34.081), 0.621

STER: Submucosal tunneling endoscopic resection; EFTR: Endoscopic full-thickness resection; ESD: Endoscopic submucosal dissection; GIST: Gastrointestinal stromal tumors.