Esophageal perforation and obstruction during retrieval of gastrointestinal stromal tumor, with final retrieval using laryngoscope

A 70-year-old female patient was found to have a 4.0 cm × 3.6 cm submucosal tumor in the gastric fundus ([Fig. 1] a). Enhanced computed tomography and endoscopic ultrasonography were performed, and the lesion was considered to be a gastrointestinal stromal tumor (GIST). Endoscopic full-thickness resection was performed, achieving complete tumor excision and gastric wall closure. Our team had previously reported that a balloon-assisted method was used to completely remove a GIST of a similar size [1]. With the assistance of the balloon, the tumor mass successfully passed through the cardia but got stuck at the esophageal entrance. Due to the extreme hardness of the tumor mass, it could not be deformed to pass through the esophageal entrance even with the assistance of the balloon. Forceful traction caused esophageal rupture, and the tumor mass was embedded in the rupture site, compressing the hypopharyngeal posterior wall. When attempting to push the tumor mass back into the stomach, it rotated through the rupture site, and the attempt failed.