Transient suction marking for re-identification of a small gastric subepithelial lesion during miniprobe endoscopic...

A 76-year-old woman underwent esophagogastroduodenoscopy, which revealed a 5-mm smooth subepithelial elevation on the anterior wall near the lesser curvature of the upper gastric body with intact overlying mucosa. This elevation became more conspicuous with insufflation. Before deflation, we created a suction mark 3 cm proximal to the lesion. Endoscopic suction was applied for 15 seconds and augmented through the working channel using a 20-mL syringe with the plunger withdrawn by 10 mL. This produced a discrete erythematous mark. Then, the stomach was deflated and filled with 250 mL of water. A 20-MHz miniprobe was advanced using the mark as a mucosal landmark without repeated endoscopic searching for the elevation. Probe insertion began 50 seconds after water instillation, and the first evaluable EUS image was obtained 14 seconds later (total time, 64 seconds). EUS demonstrated an 8-mm lesion arising from the fourth sonographic layer with an internal hyperechoic focus accompanied by acoustic shadowing. The lesion had a smooth outer margin without a cystic component. These findings suggested a small mesenchymal tumor originating from the muscularis propria. A leiomyoma and gastrointestinal stromal tumor were considered in the differential diagnosis. Surveillance endoscopy was planned at 12 months. We applied this principle to re-identify a diminutive gastric SEL after deflation and water filling for miniprobe EUS. Although a single case cannot establish superiority over conventional localization, transient suction marking may provide a simple landmark that does not require a dedicated marking device and may help preserve spatial orientation during EUS assessments.