The use of endoscopic “calabash” ligation and resection (ECLR) has some advantages to traditional submucosal excision (ESE) for the treatment of some endophytic gastrointestinal stromal tumors (GISTs), according to a study published in Cancer Medicine.

In the study, the use of ECLR yielded patient benefits during the operation and hospital stay and also resulted in fewer intraoperative and postoperative complications when compared to the use of ESE for the removal of endophytic gastric stromal tumors less than 15 mm originating from the muscularis propria.

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“The present study aimed to demonstrate the efficacy and safety of a new endoscopic technique for the treatment of GSTs ≤15 mm in diameter that originate from the muscularis propria. Our results showed that this technique was effective, relatively simple, safe, and inexpensive for treating this type of GST,” the study authors said.

Patients in the ECLR group had significantly shorter durations for the endoscopic procedures than the ESE group (22.0 ± 5.7 min vs 39.7 ± 10.45 min ;P <.001). The average hospital stay was significantly shorter for the ECLR group as well (5.07 ± 1.64 days vs 6.35 ± 4.01 days;P =.001). All patients in both groups received complete resection of the intact tumor.

The ECLR group also had significantly lower medical bills compared to the ESE group (13,686.84 ± 3016.65 Chinese yuan vs 17,502.87 ± 7514.01 Chinese yuan;P <.001).

In terms of intraoperative complications, fewer perforations were reported in the ECLR group than the ESE group (2.52% vs 9.24%; P =.029). Lower rates of postoperative complications were also reported in the ECLR group including delayed intraperitoneal infection (0% vs 5.04%; P =.039), electrocoagulation syndrome (0% vs 5.88%; P =.021), and abdominal pain scores (1.55 ± 1.0 points vs 2.16 ± 1.37 points; P <.001).

No significant differences were observed in the rates of delayed perforation, delayed hemorrhage, or respiratory tract infections. There was also no significant difference in the rates of tumor recurrence, metastasis, or mortality and no difference in the duration of follow-up between the groups.

A total of 277 patients were recruited for the study with a total of 238 ultimately compared after propensity score matching (119 patients receiving ECLR and 119 receiving ESE).


Peng MS, Zeng HT, Zhang ZL, et al. Efficacy and safety of endoscopic “calabash” ligation and resection for small gastric stromal tumors originating from the muscularis propria. Cancer Med. Published online December 12, 2022. doi:10.1002/cam4.5471