Traction-assisted endoscopic purse-string suture for an IgG4-related inflammatory pseudotumor: a case report and literature review

We report a 20-year-old female with a gastric submucosal tumor at the upper body greater curvature, successfully managed by endoscopic full-thickness resection (EFTR) using a modified traction-assisted purse-string suture. The 4.0-cm wall defect was closed in 34 min (total procedure 108 min). Pathology revealed 23 IgG4 + plasma cells/HPF, an IgG4/IgG ratio of 48%, and storiform fibrosis, meeting diagnostic criteria for IgG4-related inflammatory pseudotumor (IPT). This case demonstrates that the modified technique enables secure closure of large defects in difficult locations, and emphasizes the necessity of rigorous pathological evaluation including quantitative IgG4 assessment and differential diagnosis with inflammatory myofibroblastic tumor (IMT).