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

## TL;DR

A new clip-with-spring device improves the safety and efficiency of gastric endoscopic full-thickness resection for subepithelial lesions.

## Contribution

A novel clip-with-spring device is introduced to enhance internal traction during gastric EFTR.

## Key findings

- IT-EFTR significantly improved serosa exposure and reduced procedure and perforation times.
- IT-EFTR resulted in lower postoperative pain and shorter hospital stays compared to NA-EFTR.
- En bloc resection was achieved in 96.2% of cases with no significant difference in complication rates.

## Abstract

Effective tissue traction is crucial for gastric endoscopic full-thickness resection (EFTR) to ensure a clear visual field for the dissection site. We aimed to evaluate the effectiveness of internal traction using a novel clip-with-spring device in assisting gastric EFTR.

Twenty-six patients with gastric subepithelial lesions from the muscularis propria were enrolled for internal traction-assisted EFTR (IT-EFTR) and 26 patients for non-assisted EFTR (NA-EFTR) were enrolled as controls.

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 minutes and perforation time of 37.2 ± 29.9 minutes. En bloc resection was achieved in 50 patients (96.2%). IT-EFTR significantly improved serosa exposure score (3.4 ± 0.9 vs. 1.9 ± 0.7,
P
<0.001) and shortened total procedure time (33.0 ± 21.8 vs. 91.8 ± 38.6 min,
P
<0.001) and perforation time (19.0 ± 18.8 vs. 55.5 ± 27.8 min,
P
<0.001) compared with NA-EFTR. There were no significant differences in complication rates between the two groups. However, visual analogue score after the procedure was significantly lower (4.2 ± 1.0 vs. 4.7 ± 0.7,
P
=0.037) and postoperative hospital stay (3.7 ± 2.1 vs. 4.8 ± 1.3,
P
=0.038) was significantly shorter in the IT-ERTR group than in the NA-EFTR group.

Internal traction using the novel clip-with-spring device could significantly improve safety and efficacy of gastric EFTR in the distal stomach.