Background <p>Traction-assisted techniques have been widely applied in gastric endoscopic submucosal dissection (ESD), enabling more stable and distinct visualization of the submucosa through mucosal elevation. However, there remains a notable scarcity of reports on their application in managing large gastric mucosal lesions. Here, we present a case series introducing the application of elastic ring traction-assisted resection for large gastric mucosal lesions and evaluate its efficacy and safety.</p> Methods <p>This prospective case series study enrolled 13 patients with large gastric mucosal lesions (&gt; 3.0&#xa0;cm in diameter) who underwent an in vivo elastic ring traction-assisted ESD procedure between April 2023 and September 2024 at our endoscopic center.</p> Results <p>With the application of elastic ring traction, the mean dissection speed was 34.70&#xa0;mm²/min and the mean dissection time for ESD was 74.62&#xa0;min, even in cases with relatively large tumor sizes. During and after the operation, no perforation occurred in the elastic ring traction-assisted ESD procedures, and the intraoperative bleeding rate was 7.69%.</p> Conclusion <p>In the treatment of large gastric mucosal lesions exceeding 3.0&#xa0;cm in diameter, elastic ring traction-assisted ESD demonstrates effectiveness and safety. However, further prospective controlled studies are needed to comprehensively verify the reliability of this method.</p>