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Snare-assisted endoscopic resection of gastric subepithelial tumors originating from the muscularis propria layer: a multicenter study

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Background and Aim

Although successful endoscopic resection of gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer has been frequently reported, it requires a relatively complicated technique and has a high perforation rate. In this retrospective study, we evaluated the efficacy and safety of the snare-assisted endoscopic resection (SAER) method which is performed using a snare and insulated-tip (IT) knife via a single-channel endoscope to reduce the perforation rate.


In this study, fifty-six patients with gastric SETs originating from the MP layer treated by the SAER method at three institutions between July 2017 and December 2017 were reviewed. The procedure involved multiple steps as shown in Fig. 2. Data were obtained on demographics, SET features, histopathological diagnoses, procedure time, en bloc resection rate, R0 resection (negative margins) status, and adverse events.


Endoscopic resection was successfully performed in all patients. The median overall procedure time was 43.5 min (range 26–106 min). The mean size of resected specimens was 19.73 mm (range 10–33 mm). The overall rate of en bloc resection was 96.4% (54/56). In addition, the perforation rate was 7.1% (4/56), and defects in the stomach wall were very small and easily closed using metallic clips. No postprocedural bleeding occurred in any case.


The SAER method is an effective, safe, less costly technique for the removal of some gastric SETs originating from the MP layer with an appropriate size.

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Fig. 1
Fig. 2



Snare-assisted endoscopic resection


Subepithelial tumors


Muscularis propria




Gastrointestinal stromal tumors


Endoscopic ultrasound


High-power field


National Comprehensive Cancer Network


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We sincerely thank the staff of the endoscopy unit at General Hospital of Southern Theater Command of PLA, the First Affiliated Hospital of Soochow University, and the Clifford Hospital for their excellent technical assistance in conducting this study.


This study was supported by combined grants from the National Natural Science Foundation of China (No. 81602170), the Natural Science Foundation of Guangdong province (No. 2014A030313595), the Science and Technology Plan Project of Guangzhou City (Nos. 201804010039 and 201607010077), and the Youth Medical Key Talent Project of Jiangsu province (No. QNRC2016705).

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Correspondence to Rui Li or Yagang Zhao.

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Hongwu Zhu, Dongtao Shi, Hong Song, Meihua Zhou, Dayong Sun, Rui Li, and Yagang Zhao have no conflicts of interest or financial ties to disclose.

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Zhu, H., Shi, D., Song, H. et al. Snare-assisted endoscopic resection of gastric subepithelial tumors originating from the muscularis propria layer: a multicenter study. Surg Endosc 34, 3827–3832 (2020).

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  • Endoscopic resection
  • Gastric subepithelial tumor
  • Muscularis propria layer
  • Snare
  • Perforation
  • Bleeding