Endoscopic full-thickness resection preserving the mucosa: more is better

A 60-year-old woman with a submucosal tumor originating from the muscularis propria located in the gastric fornix (▶Fig. 1 a) was referred to our hospital. Contrast-enhanced computed tomography (CT) showed a well-defined and low-density mass close to the cardia (▶Fig. 1b). Owing to its hard-to-reach location, we decided to perform an optimized gastric endoscopic full-thickness resection (EFTR). This method preserved all the residual mucosa to achieve tension-free closure. After a submucosal saline injection, a 1.5-cm incision was made at the edge of the lesion (▶Fig. 1 c). In the current method, we performed a submucosal dissection to simultaneously create a tunnel (▶Fig. 2, ▶Video 1). Direct advancement of the endoscope into the fundus tunnel was performed, and the lesion was completely retrieved without removing any of the mucosal layers (▶Fig. 1d). A full-thickness defect was exposed after removing the mass through the tunnel (▶Fig. 1 e). Subsequently, two edges of the remaining mucosa were easily clipped together (▶Fig. 1 f, g). The total wound closure time closure was 6 minutes. The submuE-Videos