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Published on: September 11, 2021
Case Report: Cross-overlapping multi-purse-string closure of a large gastric wall defect after endoscopic
Zhiyu Ma1,2, Xuan Bai1,2, Jialong Qi1,2
1Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
Background:
Secure endoscopic closure of large gastric full-thickness defects after endoscopic full-thickness resection (EFTR) remains challenging, particularly when the defect is irregular and dedicated closure devices are unavailable or unsuitable.
Case Presentation:
A 63-year-old man underwent EFTR for a 4.5-cm gastric body lesion originating from the muscularis propria. Resection created an irregular full-thickness defect of approximately 4 cm. Three nylon loops were independently anchored around the defect margin with metal clips using deliberately staggered, partially overlapping fixation paths. Sequential tightening created a cross-overlapping mesh-like configuration and achieved complete endoscopic closure. Air insufflation showed no leakage. Postoperative imaging demonstrated no significant free air or fluid accumulation, and histopathology confirmed a low-risk gastrointestinal stromal tumor. The patient was discharged on postoperative day 7. Endoscopic follow-up at 3, 6, and 12 months demonstrated progressive mucosal healing without reperforation or stenosis.
Conclusion:
Cross-overlapping multi-purse-string closure using conventional nylon loops and metal clips was feasible in this selected large and irregular gastric defect. The technique may offer a device-accessible option when standard single-loop closure is considered insufficient, although its reproducibility and comparative effectiveness require evaluation in larger studies.
