Internal and external bidirectional traction facilitating endoscopic submucosal excavation of a huge subepithelial tumor in the fornix of the gastric fundus near the cardia

Endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFTR) are efficacious and reliable methods for managing gastrointestinal subepithelial tumors [1] [2] [3]. Some traction methods are often used to expose subepithelial tumors [3]. However, traditional traction methods may be inadequate for full exposure and complete excavation [4] [5]. To address this issue, we have developed an internal and external bidirectional traction method that has been successfully utilized in ESE ([Video 1]).