Endoscopic calabash ligation and resection (ECLR) may become the procedure of choice in some cases of gastrointestinal stromal tumor (GIST), according to a study recently published in Cancer Medicine.

“The present study aimed to demonstrate the efficacy and safety of a new endoscopic technique for the treatment of [GISTs] ≤15 mm in diameter that originate from the muscularis propria,” the authors wrote.

This retrospective study included 238 patients previously diagnosed with GIST, specifically, a small endophytic tumor with a diameter of 15 mm or less. Half of the participants constituted the control group and underwent endoscopic submucosal excision (ESE), while the remaining patients underwent ECLR.

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The mean ages were almost identical between the ESE group and ECLR group at 56.92 and 56.61 years, respectively. Likewise, the female-to-male ratios were 74/45 and 75/44 for each group, respectively. The majority of patients had a tumor diameter of 10 mm or less, with mean diameters of 7.73 mm and 7.64 mm in each group, respectively. The most common tumor location was the fundus, followed by the body, with only 1 tumor in the antrum of the stomach.

All participants achieved complete intact tumor resection. The only intraoperative complication was gastric perforation, which occurred more often in the ESE group (9.24%) than in the ECLR group (2.52%). These findings demonstrate that both techniques can achieve similar success rates.

“Subsequently, the tumor can then be easily sucked into the ligation cap through negative-pressure suction without external traction. In both groups, all [GISTs] were entirely removed in our study, which was confirmed by postoperative pathological examinations,” the authors wrote.

Postoperative complications were more frequent in the control group. The most common complication was electrocoagulation syndrome, present in 5.88% of patients undergoing ESE, followed by delayed intraperitoneal infection in 5.04%, respiratory tract infection and delayed perforation in 1.68% each, and lastly, delayed hemorrhage in 0.84%.

On the other hand, just 1 patient (0.84%) in the ECLR cohort developed a respiratory tract infection. Importantly, the mean abdominal pain scores were 2.16 in the control group vs 1.55 points in the ECLR group.


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