Endoscopic full-thickness resection of a gastric gastrointestinal stromal tumor using a scissor-type knife: a video case report

Introduction: Closure of mucosal defects after duodenal endoscopic submucosal dissection (ESD) is important to prevent postoperative adverse events.Previously, we devised an underwater reopenable-clip closure method for effective closure of mucosal defects under endoscopic guidance within the field of view.Recently, the usefulness of a method using a clip with a line passing through an accessory channel to close a mucosal defect has been reported.We also described a reopenable-clip over the line method (ROLM) to completely close margin and the muscular layers of mucosal defects using a clip line.Case Report: Our patient was a 70-year-old woman with a 40-mm duodenal tumor in the descending portion of the duodenum.The lesion was completely resected using ESD .In the result, the mucosal defect size was approximately 50 mm, representing about 3/4 of the duodenal circumference.A clip-line closure was performed using ROLM to close the mucosal defect's margins completely.An additional clip was applied to close the mucosal defect after ESD completely.Subsequently, the line was fixed with a modified locking-clip technique, closed, and cut with endoscopic scissors.The patient was discharged without any adverse events 9 days after the duodenal ESD.Discussion: Mucosal defect closure after duodenal ESD using ROLM is a novel method that can reliably close mucosal defects.