Innovative use of a long transparent cap for closure of large duodenal defects post endoscopic full-thickness...

Securing large duodenal defects after endoscopic full-thickness resection (EFTR) is challenging because of anatomic constraints. This case report describes an innovative closure technique using a modified long transparent cap in a 48-year-old man who underwent EFTR for a 2.0 × 2.5-cm duodenal bulb gastrointestinal stromal tumor, resulting in a 1.5 × 2.5-cm full-thickness defect. Titanium clips closure failed. A long ligation device cap (inner diameter 0.9 cm, outer diameter 1.1 cm) was used to suction opposing mucosal edges, enabling precise titanium clip placement under endoscopic guidance. The cap-assisted technique achieved secure defect closure. Margin-negative resection was confirmed, and the patient recovered without adverse events. To our knowledge, we report the first use of a long transparent cap that helped successfully close a large duodenal defect following EFTR, offering a practical alternative in anatomically challenging locations or resource-limited settings.