The endoscopic management of multiple gastric submucosal tumors (SMT) remains insufficiently systematically evaluated. This study aimed to assess the efficacy and safety of super minimally invasive surgery(SMIS), including endoscopic submucosal dissection (ESD), endoscopic submucosal excision (ESE), endoscopic full-thickness resection (EFTR), and submucosal tunneling endoscopic resection (STER), for treating multiple gastric SMT.

We retrospectively analyzed 53 patients diagnosed with multiple gastric SMT who underwent initial SMIS at the Department of Gastroenterology, First Medical Center of Chinese PLA General Hospital, between January 2013 and March 2025. Clinical-pathological characteristics, surgical approaches, en bloc resection rate, R0 resection rate, operative duration, major adverse events, hospitalization length, surgical costs, and follow-up outcomes were evaluated.

This study enrolled 53 patients with multiple gastric SMT, including 39 (73.6%) females and 14 (26.4%) males, with a mean age of 55.1±8.8 years.A total of 141 tumor lesions were detected, with 139(98.6%) successfully removed by endoscopic resection.The median tumor size was 8 mm (range: 2-30 mm). Histopathological analysis revealed 51(36.7%) leiomyomas, 46(33.1%) neuroendocrine tumors, 34 (24.5%) gastrointestinal stromal tumors, 4 (2.9%) lipomas, and one case each (0.7%) of ectopic pancreas, schwannoma, myofibroblastoma, and hyperplastic smooth muscle nodule. Peroral super minimally invasive non-full-thickness resection was performed on 124 (89.2%) lesions, peroral super minimally invasive full-thickness resection on 8 (5.8%) lesions, and super minimally invasive resection via tunnel approach on 7 (5.0%) lesions.The mean operative duration was 58.4±25.4 minutes.The en bloc resection rate reached 99.3% (138/139), with an R0 resection rate of 97.1% (135/139). No severe adverse events occurred during the perioperative period.Among 51 patients who completed follow-up (median: 22 months; range: 3-119 months), the recurrence rate was 2.56%(1/39)for non-neuroendocrine tumors but significantly higher for neuroendocrine tumors at 50.00%(5/10). The median postoperative hospital stay was 6 days (IQR: 5-7), with median surgical costs of ￥11, 187.3 (IQR: 8, 851.8-14, 348.3) and total hospitalization costs of ￥27, 035.1 (IQR: 24, 671.4-36, 580.8).

This study demonstrates that SMIS is a safe and effective therapeutic approach for multiple gastric SMT.