A pilot study on the application and efficacy of mucosal traction-assisted clip closure in endoscopic full-thickness resection for gastric submucosal tumors

Endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMTs) presents a technical challenge for defect closure. This study aims to evaluate the feasibility and efficacy of a novel mucosal traction-assisted clip closure (MTCC) technique compared to conventional clip closure (CCC). In this multi-center retrospective study of 218 patients undergoing EFTR for gastric SMTs at seven hospitals (June 2020-June 2025), patients were divided into MTCC (n = 32) and CCC (n = 186) groups. To minimize selection bias, 1:2 propensity score matching (PSM) yielded a matched cohort of 96 patients (MTCC, n = 32; CCC, n = 64). Primary outcomes were defect closure success rate and closure time. Secondary outcomes included postoperative complications, fasting time, and hospital stay. Subgroup analyses were performed by defect diameter (≤ 2.5 cm vs. >2.5 cm) and tumor location (gastric fundus). Defect closure was successfully achieved in all patients in the MTCC group. After PSM, baseline characteristics were well-balanced between the two groups. The MTCC group continued to demonstrate superior closure efficiency compared to the CCC group, with a significantly shorter median defect closure time (7.0 min vs. 17.0 min, P < 0.001) and fewer titanium clips used (8.0 vs. 12.0, P < 0.001). The median total procedure time was also significantly reduced in the MTCC group (47.0 min vs. 53.0 min, P = 0.027). Postoperatively, patients in the MTCC group had a shorter median fasting time (2.0 days vs. 3.0 days, P = 0.001), while complication rates remained comparable between groups. The advantages of MTCC were consistently observed across subgroups stratified by defect size and tumor location. After adjusting for potential confounders using PSM, the MTCC technique appears to be a feasible method for managing post-EFTR defects. In this cohort, it was associated with significantly enhanced closure efficiency and accelerated postoperative recovery.