Successful resection of a giant well-differentiated liposarcoma using a modified snare technique

A 75-year-old woman presented with progressive dysphagia and was subsequently admitted to our hospital. Gastroscopy revealed a giant 21-cm lesion originating from the esophageal inlet and prolapsing through the cardia ([ Fig. 1a–b ]). Preoperative computed tomography and endoscopic ultrasonography identified a massive intraluminal mass with well-demarcated mixed-echoic structures embedded within predominant hyperechoic areas and scattered calcifications, highly suggestive of a liposarcoma ([ Fig. 2a–b ]). Following a preoperative discussion, endoscopic resection was planned. Fig. 1 Preoperative endoscopic views. ( a and b ) A 21-cm giant pedunculated lesion occupies the esophageal lumen, extending from the esophageal inlet down to the gastric cardia. Fig. 2 Preoperative computed tomography (CT) and endoscopic ultrasonography (EUS) evaluation. ( a ) A giant soft-tissue mass (yellow outline) occupied the esophageal lumen and extends to the gastroesophageal junction. ( b ) The mass (yellow dashed outline) displayed heterogeneous echogenicity, featuring well-demarcated mixed-echoic structures within predominant hyperechoic areas and scattered calcifications. During the procedure, forceps-assisted traction was employed to guide the snare and optimize exposure, definitively confirming a broad pedicle base at the postcricoid region ([ Fig. 3a ]). Although the lesion was pedunculated, the narrow lumen and broad pedicle posed a significant risk of anatomical disorientation during conventional endoscopic submucosal dissection (ESD). To encompass the broad base, we applied a modified snare technique. Two conventional snares were intertwined to form a larger, integrated assembly, which was looped around the pedicle base to ensure full circumferential contact to facilitate a precise and secure hot-snare resection ([ Fig. 3b ]). Subsequently, a third snare was applied to constrict the assembly, ensuring secure ligation ([ Fig. 3c ]). Hot snare resection was then performed ([ Fig. 3d–e ], [ Video 1 ]). No intraprocedural or postprocedural adverse events (e.g., bleeding, perforation, or infection) occurred. Follow-up endoscopy at 3 months revealed complete mucosal healing with no evidence of the luminal stricture ([ Fig. 3f ]), and the patient remained asymptomatic. Given the large size of the resected lesion, en bloc transoral retrieval was not feasible. We therefore extracted the specimen in a piecemeal fashion and reconstructed ex vivo to verify its intact morphology ([ Fig. 4 ]). Histopathological analysis confirmed a well-differentiated liposarcoma (WDLPS). Fig. 3 Procedural steps of the modified snare technique and follow-up. ( a ) Forceps-assisted traction guided the snare to optimize exposure, confirming a broad pedicle base at the postcricoid region (the yellow arrow indicated the snare sheath). ( b ) Two conventional snares were intertwined. ( c ) A third snare was applied to constrict the coupled snares. ( d ) A macroscopic view of the excised specimen (the yellow arrow indicated the broad pedicle base). ( e ) The mucosal defect at the postcricoid region. ( f ) Gastroscopy at 3 months confirmed complete mucosal recovery with a stable scar. Video 1 Demonstration of the endoscopic resection of a 21-cm giant well-differentiated liposarcoma using a modified snare technique. Download Video Fig. 4 Specimen reconstruction. The piecemeal specimens were reconstructed ex vivo to verify the original 21-cm morphology. Esophageal WDLPSs are rare pedunculated lesions typically arising from the restricted postcricoid region, with therapeutic options ranging from surgical resection to various endoscopic interventions.[ 1​ ] [ 2​ ] [ 3​ ] [ ​4​ ] For such broad-based lesions, conventional ESD often carries a high risk of anatomical disorientation, while peroral protrusion remains unfeasible. Our modified snare technique offers a safe, cost-effective, and reproducible alternative that simplifies the management of broad-pedicled challenging giant lesions. Endoscopy_UCTN_Code_TTT_1AO_2AG_3AB. Publication History Received: 22 May 2026 Accepted after revision: 13 June 2026 Article published online: 30 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany