Bridge technique self-traction improves outcomes over conventional endoscopic submucosal dissection for semicircumferential gastric cardia neoplasms in a randomized controlled trial

To compare the efficacy and safety of the novel "Bridge Technique" self-traction endoscopic submucosal dissection (BT-ESD) versus conventional ESD (C-ESD) for treating semi-circumferential or larger superficial neoplasms of the gastric cardia. A single-center, randomized controlled trial. The First Hospital of Putian City of Fujian Province, China for period of July 2020 to December 2023. Eighty patients with gastric cardia adenoma or early carcinoma were enrolled and randomly allocated to either the BT-ESD group or the C-ESD group. Outcome measures included lesion size (longest diameter), procedure time, resection speed, submucosal injection volume, en bloc resection rate, frequency of intraprocedural bleeding, hospitalization duration, and complications (perforation, postoperative bleeding, infection). The mean lesion long diameter was comparable between groups (BT-ESD: 55.7 ± 15.6 mm; C-ESD: 55.2 ± 10.6 mm). Compared to the C-ESD group, the BT-ESD group demonstrated a significantly shorter procedure time, lower submucosal injection volume, and reduced frequency of intraprocedural bleeding (all p < 0.05). Resection speed was significantly faster in the BT-ESD group. The en bloc resection rate was higher and the postoperative infection rate was lower in the BT-ESD group (p < 0.05). Overall complication rates were lower with BT-ESD, but the difference was not statistically significant(p > 0.05). For large (≥ semi-circumferential) superficial lesions of the gastric cardia, the "Bridge Technique" self-traction ESD is a safe, efficient, and rapid approach. The BT-ESD technique demonstrated favorable outcomes in terms of procedure time, en bloc resection rate, and intraprocedural bleeding compared with conventional ESD. This device-free self-traction method represents a useful addition to the endoscopic toolbox for large cardia lesions, but further studies are needed to compare it with other traction-assisted techniques.Trial registration: Chinese Clinical Trial Registry, ChiCTR2600119809 Date of retrospectively Registration March 4, 2026.