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Background and aims <p>Endoscopic full-thickness resection (EFTR) is a promising yet technically demanding procedure for gastric submucosal tumors originating from the muscularis propria (SMT-MPs). Traction and ligation are commonly employed to facilitate resection. This study compared ligation-assisted EFTR (EFTR-L) with intraluminal snare traction-assisted EFTR (EFTR-S) for small (≤ 1.5&#xa0;cm) gastric SMT-MPs.</p> Methods <p>We retrospectively analyzed a cohort of 179 consecutive patients who underwent EFTR-L or EFTR-S for small gastric SMT-MPs at a single tertiary center between January 2018 and March 2024. To mitigate significant baseline imbalances and selection bias, a dual analytical approach was employed. First, 1:1 propensity score matching (PSM) was performed, yielding 27 matched pairs. Second, multivariable regression models were used to corroborate the findings in the total cohort.</p> Results <p>In the propensity-matched cohort (<i>n</i> = 54), baseline characteristics were well balanced. Both techniques achieved a 100% complete resection rate. However, the EFTR-L group demonstrated significant advantages in procedural metrics and patient outcomes. Mean operative time was substantially shorter (12 vs. 55 min, <i>P</i> &lt; 0.001), fewer clips were required for defect closure (4.37 vs. 5.11, <i>P</i> = 0.014), and operation total costs were lower ($1174.56 vs. $1692.37, <i>P</i> &lt; 0.001). Clinically, no patient in the EFTR-L group experienced postoperative abdominal pain, compared to 29.6% in the EFTR-S group (<i>P</i> = 0.008). These findings were confirmed by multivariable analysis of the total patient cohort. No tumor recurrence was observed in either group during follow-up.</p> Conclusion <p>For gastric SMT-MPs ≤ 1.5&#xa0;cm, ligation-assisted EFTR is a superior alternative to snare-based traction. It offers equivalent complete resection rates while being significantly faster, more cost-effective, and associated with less postoperative pain. EFTR-L should be considered a preferred therapeutic strategy in this setting.</p> Graphical abstract <p></p>

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Comparison of ligation-assisted versus snare traction-assisted endoscopic full-thickness resection for small (≤ 1.5 cm) gastric submucosal tumors originating from the muscularis propria: a propensity score-matched analysis

  • 期刊论文

  • 发表日期：

    2026年2月19日

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  • Shizhe Li,
  • Yu Wu,
  • Miao Ouyang,
  • Qian Li,
  • Lei Gu,
  • Xiaowei Liu

摘要

Background and aims

Endoscopic full-thickness resection (EFTR) is a promising yet technically demanding procedure for gastric submucosal tumors originating from the muscularis propria (SMT-MPs). Traction and ligation are commonly employed to facilitate resection. This study compared ligation-assisted EFTR (EFTR-L) with intraluminal snare traction-assisted EFTR (EFTR-S) for small (≤ 1.5 cm) gastric SMT-MPs.

Methods

We retrospectively analyzed a cohort of 179 consecutive patients who underwent EFTR-L or EFTR-S for small gastric SMT-MPs at a single tertiary center between January 2018 and March 2024. To mitigate significant baseline imbalances and selection bias, a dual analytical approach was employed. First, 1:1 propensity score matching (PSM) was performed, yielding 27 matched pairs. Second, multivariable regression models were used to corroborate the findings in the total cohort.

Results

In the propensity-matched cohort (n = 54), baseline characteristics were well balanced. Both techniques achieved a 100% complete resection rate. However, the EFTR-L group demonstrated significant advantages in procedural metrics and patient outcomes. Mean operative time was substantially shorter (12 vs. 55 min, P < 0.001), fewer clips were required for defect closure (4.37 vs. 5.11, P = 0.014), and operation total costs were lower ($1174.56 vs. $1692.37, P < 0.001). Clinically, no patient in the EFTR-L group experienced postoperative abdominal pain, compared to 29.6% in the EFTR-S group (P = 0.008). These findings were confirmed by multivariable analysis of the total patient cohort. No tumor recurrence was observed in either group during follow-up.

Conclusion

For gastric SMT-MPs ≤ 1.5 cm, ligation-assisted EFTR is a superior alternative to snare-based traction. It offers equivalent complete resection rates while being significantly faster, more cost-effective, and associated with less postoperative pain. EFTR-L should be considered a preferred therapeutic strategy in this setting.

Graphical abstract