While conventional endoscopic full-thickness resection (C-EFTR) can completely remove gastric subepithelial lesions (SELs) originating from the muscularis propria or with predominant extraluminal growth, operating on lesions in "difficult locations" such as the gastric fundus, fornix, and lesser curvature of the gastric body is often challenging due to difficult endoscopic positioning. Double-loop ligation endoscopic full-thickness resection (DL-EFTR) creates a pseudo-pedunculated, polyp-like morphology by applying double loops at the lesion base using a ligation device, theoretically reducing technical difficulty and resection time. This study is the first multicenter retrospective cohort comparison of the clinical efficacy and economic differences between DL-EFTR and C-EFTR for gastric SELs ≤15 mm.

Patients with gastric SELs who underwent DL-EFTR or C-EFTR between March 2023 and September 2025 at South China Hospital, Shenzhen University, and Shenzhen Baoan Central Hospital were included. All procedures were performed by senior endoscopists, and the study was approved by the ethics committee. A 1:1 propensity score matching (PSM) was performed using gender, age, lesion size, location, and pathological type as covariates. After balancing baseline characteristics, operative time, technical success rate, complete resection rate, postoperative nasogastric tube placement rate, hospital stay, and costs were compared between the two groups.

Sixty-six patients (22 DL-EFTR, 44 C-EFTR) were initially analyzed. After PSM, 13 patients remained in each group, with no significant differences in baseline characteristics. The median operative time was significantly shorter in the DL-EFTR group (28.5 min vs. 49.0 min, P<0.05). The technical success and complete resection rates were 100% in both groups. Significantly fewer patients in the DL-EFTR group required postoperative nasogastric tube placement (2 cases, 15.4%) compared to the C-EFTR group (9 cases, 69.2%) (P<0.05). No significant difference was found in hospital stay (6.4±3.0 d vs. 6.6±1.6 d, P>0.05). Both procedure costs and total hospitalization costs were significantly lower in the DL-EFTR group (all P<0.05). No severe complications, such as intraoperative perforation, hemorrhage, or delayed bleeding, occurred in either group.

For gastric SELs ≤15 mm, DL-EFTR ensures complete resection while significantly shortening operative time, reducing the need for nasogastric tube placement, and lowering medical costs, representing a safe, economical, and easily promotable innovative endoscopic technique. Limited by its retrospective design, prospective, large-sample, randomized controlled trials are needed to further validate its long-term efficacy and safety.