Endoscopic full-thickness resection preserving the mucosa: more is better

A 60-year-old woman with a submucosal tumor originating from the muscularis propria located in the gastric fornix ([Fig. 1 a]) was referred to our hospital. Contrast-enhanced computed tomography (CT) showed a well-defined and low-density mass close to the cardia ([Fig. 1 b]). Owing to its hard-to-reach location, we decided to perform an optimized gastric endoscopic full-thickness resection (EFTR). This method preserved all the residual mucosa to achieve tension-free closure. After a submucosal saline injection, a 1.5-cm incision was made at the edge of the lesion ([Fig. 1 c]). In the current method, we performed a submucosal dissection to simultaneously create a tunnel ([Fig. 2], [Video 1]). Direct advancement of the endoscope into the fundus tunnel was performed, and the lesion was completely retrieved without removing any of the mucosal layers ([Fig. 1 d]). A full-thickness defect was exposed after removing the mass through the tunnel ([Fig. 1 e]). Subsequently, two edges of the remaining mucosa were easily clipped together ([Fig. 1 f, g]). The total wound closure time closure was 6 minutes. The submucosal tumor measured 25 mm at the highest diameter externally ([Fig. 1 h]). Postoperatively, the patient remained asymptomatic and was discharged on the third day without any complications.