ArticleSurgical endoscopy2026
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.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsEndoscopic 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.
methodsWe 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.
resultsIn 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.
conclusionFor 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.
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