With increased use of upper gastrointestinal endoscopy, more and more submucosal tumors (SMTs) are being diagnosed [1]. Although most patients with gastric SMTs are asymptomatic, a small number may present with abdominal pain or gastrointestinal obstruction or bleeding [2]. Some SMTs, such as gastric stromal tumors, have a tendency for malignant change [3], [4], and patients therefore need repeated follow-up examinations. However, some patients do not comply with advice regarding regular follow-up [5]. Moreover, repeated follow-up increases medical costs and psychological stress [6], and most patients therefore opt for early endoscopic resection of the tumor.

Endoscopic resection of gastric SMTs can be by endoscopic submucosal dissection (ESD), submucosal tunnel endoscopic resection (STER), endoscopic submucosal excavation (ESE), or endoscopic full-thickness resection (EFTR) [7]. ESD is not suitable for extraluminal gastric SMTs [8]. STER is suitable for SMTs of the cardia but, for submucosal tumors located in other parts of the stomach, it is relatively difficult to establish tunnels [9]. Therefore, ESE and EFTR are the most commonly used endoscopic minimally invasive methods for treatment of gastric SMTs. ESE and EFTR are relatively difficult procedures, but several authors have shown that application of traction can shorten the operation time and reduce complications [6], [10], [11].

Our team has previously reported the use traction applied via elastic orthodontic rubber band (ORB) and clip to shorten procedure time during ESD of colorectal lesions [12]. The use of ORB-assisted ESE or EFTR of gastric SMTs has not been reported to date. This study aimed to explore the feasibility and safety of ORB-assisted ESE (ORB-ESE) or ORB-assisted EFTR (ORB-EFTR) in the treatment of gastric SMTs.