Traction-preclosure-assisted vs conventional endoscopic full-thickness resection for gastric subepithelial tumors: Safety, efficacy in a retrospective cohort (with video)

doi:10.3748/wjg.v32.i19.112955

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Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. May 21, 2026; 32(19): 112955
Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.112955

Traction-preclosure-assisted vs conventional endoscopic full-thickness resection for gastric subepithelial tumors: Safety, efficacy in a retrospective cohort (with video)

Xin Li, Ren-Yi Zhang, Xu-Dong Wen, Xue-Qin Li, Wei-Hui Liu

Xin Li, Ren-Yi Zhang, Xue-Qin Li, Wei-Hui Liu, Department of Gastroenterology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China

Xu-Dong Wen, Department of Gastroenterology and Hepatology, Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China

Co-first authors: Xin Li and Ren-Yi Zhang.

Author contributions: Li X drafted the manuscript; Zhang RY and Wen XD performed the experiments; Li XQ conducted data analysis and interpretation; Liu WH critically revised the manuscript and provided financial support; Li X and Zhang RY jointly organized the research process and participated in data interpretation as co-first authors; all authors read and approved the final manuscript.

Supported by Key Research and Development Projects of Sichuan Province, China, No. 2021YFS0375.

Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Sichuan Provincial People’s Hospital, No. 2024515.

Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No additional data are available.

Corresponding author: Wei-Hui Liu, MD, PhD, Department of Gastroenterology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, No. 270 Rongdu Avenue, Jinniu District, Chengdu 610000, Sichuan Province, China. audiliu12@163.com

Received: August 11, 2025
Revised: January 24, 2026
Accepted: March 12, 2026
Published online: May 21, 2026
Processing time: 280 Days and 19.5 Hours

Abstract

BACKGROUND

Gastric subepithelial tumors (SETs), commonly encountered in gastrointestinal practice, require precise and complete resection to prevent recurrence and malignant transformation.

AIM

To compare efficacy, safety, and clinical outcomes between traction-preclosure (TPC)-assisted endoscopic full-thickness resection (EFTR) and conventional EFTR for gastric SETs.

METHODS

We retrospectively analyzed 214 patients who underwent EFTR for gastric SETs, assigning them to the conventional EFTR (n = 129) or TPC-EFTR (n = 85) group. Primary outcomes were complete and en bloc resection rates. Secondary outcomes included procedural efficiency (operation time, closure time, time to resumption of diet and defecation), safety (adverse events, blood parameters, pneumoperitoneum), and clinical efficacy (pain scores, EuroQol visual analogue scale, health utility values, recurrence rate). Recurrence-free survival was assessed by Kaplan-Meier analysis.

RESULTS

Compared to the conventional EFTR group, the TPC-EFTR group had a higher complete resection rate (95.3% vs 86.8%, P = 0.041), shorter operation time [60.0 (40.0) minutes vs 70.0 (39.5) minutes, P = 0.047], shorter closure time (13.0 ± 4.5 minutes vs 14.3 ± 4.5 minutes, P = 0.044), and lower pneumoperitoneum incidence (4.7% vs 14.0%, P = 0.033). The TPC-EFTR group showed higher postoperative EuroQol visual analogue scale scores [79.9 (7.6) vs 79.3 (2.0), P = 0.001] and health utility values [95.0 (4.0) × 10^-2 vs 92.0 (14.0) × 10^-2, P = 0.002]. Kaplan-Meier curves showed comparable median recurrence-free survival between the two groups [not reached (95% confidence interval: 26.0-not reached) months vs 75.0 (95% confidence interval: 60.0-75.0) months, P = 0.770].

CONCLUSION

TPC-EFTR is safe and effective strategy gastric SETs, enhancing procedural efficiency and postoperative quality of life while potentially achieving comparable or superior long-term oncological outcomes vs conventional EFTR.

Keywords: Gastric subepithelial tumors; Endoscopic full-thickness resection; Traction method; Pre-closure technique; Recurrence-free survival

Core Tip: This retrospective cohort study compared traction-preclosure-assisted endoscopic full-thickness resection (EFTR) with conventional EFTR for gastric subepithelial tumors. traction-preclosure-EFTR improved complete resection rates, shortened operation and closure times, and reduced pneumoperitoneum incidence while enhancing postoperative quality of life (higher EuroQol visual analogue scale and health utility values) without increasing recurrence risk, demonstrating superior efficacy and safety.