Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions.

Endoscopic submucosal excavation (ESE) is an established technique for managing gastric subepithelial lesions (SELs). This article presents a detailed protocol for an improved technique: longitudinal incision ESE. The core innovation involves making a straight-line incision along the central axis of the lesion, rather than a conventional circumferential one, followed by lesion retrieval and primary defect closure with metal clips. The protocol's feasibility and technical outcomes are supported by a retrospective study of 52 patients, where the longitudinal incision group (n=21) showed a 100% procedural success rate and a significantly shorter mean operation time compared to the conventional circular incision group (51.43 ± 5.56 min vs. 70.00 ± 6.96 min, P=0.0179). Furthermore, the longitudinal incision appeared to reduce the necessity for advanced closure devices (5% vs. 28%) and was associated with a low complication profile. This protocol highlights that the longitudinal incision technique may be a safe, effective, and feasible treatment for patients with gastric intracavitary SELs ≤ 2 cm, potentially offering distinct practical advantages in operative efficiency, defect management, and consumable usage.