Ligation-assisted endoscopic full-thickness resection combined with preloaded sutures for tiny mesenchymal tumors of the gastric fundus

Gastrointestinal stromal tumors (GISTs) are the most prevalent tumors of mesenchymal tissue origin in the gastrointestinal tract [1]. Currently, the treatment of small GISTs (≤2 cm) and micro-GISTs (<1 cm) remains controversial. Endoscopic full-thickness resection (EFTR) is indicated for microscopic GISTs originating from the intrinsic muscularis propria, facilitating thorough tumor removal and minimizing the risk of dissemination [2]. The fundus of the stomach is one of the commoner sites for GISTs, and performing EFTR here requires high levels of endoscopic skill and, because of the small size of the tumor, it is very easy for it to fall into the abdominal cavity after the final resection [3]. To overcome this challenge, we used a transparent cap-assisted endoscopic full-thickness ligation (EFTR-L) technique combined with preloaded sutures ([Video 1]), which allowed not only complete tumor resection and rapid specimen recovery, but also the prevention of intraoperative bleeding and perforation by use of the preloaded sutures.