Hybrid endoscopic full thickness resection for a gastric submucosal tumor

A 53-year-old woman was diagnosed with a 15-mm submucosal tumor located in the fundus of the stomach. Endoscopic ultrasonography suggested that the tumor originated from the muscularis propria layer. Therefore, we decided to use a novel hybrid EFTR to remove the lesion. First the tumor was marked and the mucosal was incised, followed by primary tumor dissection. Then the endoscope was withdrawn. A snare was fixed to the transparent cap at the front end of the endoscope without passing through the working channel. The endoscope and snare were inserted together near the lesion. A foreign body forceps was inserted through the endoscopic working channel to grasp the top of the tumor and lift it up. After adequately exposing the tumor, the snare was released to enclose the base of the tumor, and completely excised was performed under direct view. Finally, the wound was closed with clips and endoloop. The entire operation time was less than 20 minutes. The patient was discharged soon after the operation without any adverse events.