Published online Oct 15, 2026. doi: 10.4251/wjgo.122053
Revised: May 12, 2026
Accepted: June 23, 2026
Published online: October 15, 2026
Processing time: 162 Days and 1.2 Hours
Endoscopic subserosal dissection (ESSD) is a novel technique for treating gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer. This technique preserves serosal integrity and prevents perforation, but it requires advanced technical skills due to limited operational perspective and complex maneuvering. Endoscopic traction technique has been shown to improve visualization during endoscopic procedures, reduce procedural difficulty, and thereby lower the risk of complications. We integrated these two approaches and refined them into a novel therapeutic method.
To introduce traction-assisted ESSD, and evaluate its safety and feasibility in the treatment of gastric SETs.
This single-center, retrospective case series included 22 patients diagnosed with gastric SETs of MP origin. All procedures were performed by a single experienced endoscopist using traction-assisted ESSD.
Traction-assisted ESSD was performed in 22 patients with a 100% complete resection rate. The average lesion size was 1.7 ± 1.2 cm (range: 0.6-6.5 cm), and the average operative duration was 32.3 ± 15.4 minutes (range: 12-71 minutes). The lesions were diagnosed as gastrointestinal stromal tumors (8 cases), leiomyomas (10 cases), and spindle cell tumors (4 cases). All gastric wall defects were successfully closed endoscopically, with no adverse events such as bleeding, perforation, or peritonitis.
Traction-assisted ESSD is a feasible and safe technique for treating gastric SETs originating from the MP layer.
Core Tip: The primary innovation of this study is the first-time integration of the endoscopic traction technique with endoscopic subserosal dissection, establishing a novel endoscopic strategy for managing gastric subepithelial tumors originating from the muscularis propria layer. This approach integrates the key advantages of both endoscopic subserosal dissection and traction techniques, enabling complete resection of the lesion while preserving serosal integrity - thereby substantially reducing the risk of serious complications. Moreover, it reduces procedural difficulty and enhances reproducibility.