Abstract
BACKGROUND: The clinical management of small gastric submucosal tumors originating from the muscularis propria layer is a non-negligible challenge. We have proposed a safe and simple method called precutting endoscopic band ligation (EBL). AIM: To assess the long-term viability of endoscopic submucosal dissection (ESD) and precutting EBL and clarify precutting EBL's safety and efficacy. METHODS: In this retrospective study, 94 patients with small gastric muscularis propria tumors underwent ESD or precutting EBL at a tertiary hospital. Patient demographics, tumor characteristics, procedure details, adverse events (AEs), and long-term follow-up data were collected. The number of participants was determined to provide sufficient statistical power for the analyses. Continuous variables were analyzed using t-tests or Mann-Whitney U tests, and categorical variables with χ (2) or Fisher's exact tests. Multivariate linear regression with inverse probability of treatment weighting balanced baseline differences between groups. RESULTS: We reviewed 94 patients with gastric submucosal tumors originating from the muscularis propria layer (< 20 mm), including 48 treated by ESD and 46 by precutting EBL. No local recurrences were detected in either group during follow-up, and the median follow-up period was 48.60 months (interquartile range: 48.00-60.00) in the ESD group and 52.00 months (interquartile range: 36.00-84.00) in the precutting EBL group. However, precutting EBL was significantly superior in terms of operative time (46 minutes vs 17 minutes, P < 0.001) and the AE rate (11.47% vs 0%, P = 0.024). CONCLUSION: Precutting EBL had a shorter operative time than ESD and was associated with no AEs. Future randomized controlled studies are required to confirm the feasibility of this approach.