Submucosal tunneling endoscopic resection in retroflexion for gastric gastrointestinal stromal tumor of the fundus

Endoscopic resection of gastrointestinal stromal tumors of the fundus is challenging due to the need for full-thickness resection and the difficulties of defect closure. Submucosal tunneling under direct view through the esophagus can be carried out for esophageal tumors and gastric tumors of the cardia near the gastroesophageal junction. However, for tumors located at the fundus this is not feasible. In this video ([Video 1]), we present the resection strategy for a gastric gastrointestinal stromal tumor (GIST) located at the fundus ([Fig. 1]), utilizing submucosal tunneling endoscopic resection (STER) in retroflexion combined with clip-and-band traction, together with clip-and-loop closure of the mucosal defect.