Endoscopic “calabash” ligation and resection for small gastric mesenchymal tumors

Figure 1 Endoscopic submucosal excavation for treatment of small gastric mesenchymal tumors. A: Small gastric mesenchymal tumor (sGMT) located at the gastric fundus near the cardia; B: Electrocautery markings visible on the sGMT’s surface; C: Submucosal injection around the sGMT; D: Incision of the mucosal surface using a mucosal incision knife (MIK) to expose the tumor; E: Separation of the tumor from its base using a MIK; F: The wound after complete tumor dissection; G: Closure of the wound using titanium clips; H: The completely resected tumor.

Figure 2 Endoscopic “calabash” ligation and resection for treatment of small gastric mesenchymal tumors. A: Electrocoagulation imprints visible on the small gastric mesenchymal tumor (sGMT)’s surface; B: Submucosal injection around the sGMT; C: Incision of the mucosa on the surface of the sGMT using the tip of an electrosurgical snare; D: Protrusion of the tumor after negative pressure suction; E: First nylon loop ligating of the tumor base; F: Formation of the “calabash” shape after a second nylon loop, and resection of the tumor situated in the superior portion of the “calabash” utilizing the electrosurgical snare; G: Intact lower part of the “calabash” without perforation, with reinforcement ligation using a nylon loop; H: Completely resected tumor specimen.

Figure 3 Schematic diagram of endoscopic “calabash” ligation and resection for managing endophytic gastric stromal tumors. Electrocoagulation is utilized to create markings on the tumor surface, followed by submucosal injection. A transparent ligation cap is then employed, and the tumor is revealed by incising the mucosa and submucosa layers. Ligation is performed using two nylon rings to create a “calabash” shape. The gastric stromal tumor located in the superior portion of the “calabash” is resected using a snare, while ligation of the inferior portion is carried out to prevent perforation.

Figure 4 Flowchart of study subject selection process. GMT: Gastric mesenchymal tumors; EUS: Endoscopic ultrasonography; GST: Gastric stromal tumors; GL: Gastric leiomyomas; GS: Gastric schwannomas; ESE: Endoscopic submucosal excavation; PSM: Propensity score matching; ECLR: Endoscopic “calabash” ligation and resection.