Efficacy of a snare-based hybrid endoscopic submucosal dissection technique in the management of esophageal submucosal tumors.

To assess the safety and clinical outcomes of snare-assisted hybrid endoscopic submucosal dissection (H-ESD) versus conventional endoscopic mucosal resection (EMR) for esophageal submucosal tumors (SMTs). A retrospective analysis was conducted on 270 patients with esophageal SMTs treated at three centers (2020–2024), including 102 H-ESD and 168 EMR cases. The primary endpoint was the en bloc resection rate. Secondary endpoints included operative duration and postoperative outcomes. Subgroup analyses focused on tumors ≤ 10 mm and muscularis mucosa (MM)-confined lesions. H-ESD achieved higher en bloc resection rates (99.0% vs. 88.7%, P = 0.002) but longer procedure times (11.2 ± 2.2 vs. 9.9 ± 2.4 min, P < 0.001) and more clip usage (P = 0.008). Postoperative complications and hospitalization duration were similar (P > 0.05). H-ESD reduced incomplete resection risk (OR = 0.08, P = 0.014), with superior performance in small tumors (98.9% vs. 86.8%, P = 0.003) and MM-layer lesions (98.9% vs. 88.1%, P = 0.006). Snare-assisted H-ESD is a safe and effective approach for esophageal SMTs. It provides near-complete en bloc resection with acceptable procedure times and may be considered in experienced centers for small, superficial esophageal SMTs.