Internal traction in endoscopic full-thickness resection for gastric subepithelial lesions arising from the muscularis propria: a comparative study

Background: Effective tissue traction is crucial for gastric endoscopic full-thickness resection (EFTR) to ensure a clear visual field for the dissection site. We aim to evaluate the effectiveness of internal traction using a novel clip-with-spring device in assisting gastric EFTR. Patients: A total of 26 patients with gastric subepithelial lesions from the muscularis propria were enrolled for internal traction-assisted EFTR (IT-EFTR) and other 26 patients for non-assisted EFTR (NA-EFTR) were enrolled as controls. Results: The average tumor size was 1.5 ± 0.4 cm. All EFTRs were completed successfully with an average total procedure time of 62.4 ± 43.0 min and perforation time of 37.2 ± 29.9 min. En bloc resection was achieved in 50 patients (96.2%). IT-EFTR significantly improved the serosa exposure score (3.4 ± 0.9 vs. 1.9 ± 0.7, P < 0.001) and shortened the total procedure time (33.0 ± 21.8 vs. 91.8 ± 38.6 min, P < 0.001) and the perforation time (19.0 ± 18.8 vs. 55.5 ± 27.8 min, P < 0.001), when compared with NA-EFTR; The complication rates had no significant difference between the two groups. However, the visual analogue score after operation was significantly lower (4.2 ± 1.0 vs. 4.7 ± 0.7, P = 0.037) and the postoperative hospital stay (3.7 ± 2.1 vs. 4.8 ± 1.3, P = 0.038) was significantly shorter in patients of IT-ERTR group than that of NA-EFTR group. Conclusions: Internal traction using the novel clip-with-spring device could significantly improve the safety and efficacy of gastric EFTR in the distal stomach.