A new technique called endoscopic “calabash” ligation and resection (ECLR) is safe and effective to treat patients with endophytic gastric stromal tumors originating from the muscularis propria and measuring 15 mm or less. This is according to a new study that appeared in the journal Cancer Medicine

In order to compare the safety and efficacy of ECLR with that of endoscopic submucosal excision, a team of researchers from China conducted a retrospective study in 277 patients with gastric stromal tumors, the most common type of gastrointestinal stromal tumors (GIST), who were treated at the Second Clinical Medical College, Jinan University, in Shenzhen, China from February 2019 to December 2020.

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Of these 277 patients, 135 received ECLR while the remaining 142 accepted endoscopic submucosal excision. Following propensity score matching, the researchers selected 119 patients from each group to include in their study. 

The results showed that the duration of the procedure, the length of hospital stay following the operation, and the medical expenses of patients treated with ECLR were significantly lower than the others. 

Moreover, the incidence rates of stomach perforation during the operation and intraperitoneal infection, and electrocoagulation syndrome after the operation were lower in patients treated with ECLR. 

Finally, the intensity of pain after the operation was lower in patients who were treated with ECLR.

“There were no significant differences in the other measurements between the two groups,” the researchers reported.

They concluded that ECLR can be recommended as a new endoscopic procedure for the treatment of small gastric stromal tumors originating from the muscularis propria.

In ECLR, 2 nylon rings are used. The first of these is placed at the bottom of the tumor while the second is placed to tighten the stomach wall to form a “calabash”. Then using an electric snare the upper part of the “calabash”, which contains the tumor is excised while the lower part is tightened by the nylon ring to avoid perforation.


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