Underwater and traction-assisted endoscopic submucosal dissection in the gastric fundus using a multibending endoscope

The gastric fundus is the most challenging site for endoscopic submucosal dissection (ESD) because accessing the fundus with the tip of the endoscope is difficult. Furthermore, the wall of the fundus is thin and the knife-edge is pointed towards the muscle layer. A combination of the previously reported effective methods, namely, a multibending endoscope [1], multiloop traction [2], and underwater technique [3] may offer safe treatment in the fundus. Herein, we report a successful ESD performed by a trainee using these three methods.