Endoscopic resection of a huge tumor located at an anatomically challenging position using an innovative extra snare traction method

A 56-year-old man was admitted to our hospital with a 20-day history of intermittent abdominal pain. Enhanced computed tomography of the abdomen revealed a huge submucosal mass in the duodenal bulb. Upper gastrointestinal endoscopy showed a huge irregular mass occupying the entire duodenal lumen, making it impossible to visualize the complete extent under endoscopy, indicating inevitable traumatic open surgery ([Fig. 1] a). However, endoscopic ultrasound showed intact submucosal and muscular layers, suggesting the possibility of endoscopic resection ([Fig. 1] b). After obtaining patient consent and explaining the standard of care alternatives, we decided to perform endoscopic resection of the lesion.