Endoscopic sutured purse-string resection: a novel technique for resection of large gastric subepithelial lesions

Subepithelial lesions (SELs) in the gastrointestinal (GI) tract are common and often necessitate removal, particularly when >20 mm 1 2. The choice of endoscopic resection depends on various factors, including lesion characteristics, location, and evidence of deeper tissue involvement 2 3. Challenges in achieving full-thickness resection have driven the development of innovative over-the-scope devices 4. However, these devices are typically restricted to lesions <30 mm, and their size and rigidity often hinder passage beyond the pharynx. We present here a novel technique for accomplishing full-thickness resection of SELs, known as endoscopic sutured purse-string resection (ESPR). ESPR employs the Overstitch device (Apollo Endosurgery, Austin, Texas, USA), a well-established tool for placing full-thickness endoscopic sutures. It involves creating a purse-string configuration around the lesion (Fig. 1) before resection, enabling the safe and complete removal of even larger lesions.