A modified exposed endoscopic full‐thickness resection: Traction‐assisted resection while defect closing

Objectives Exposed endoscopic full‐thickness resection (Eo‐EFTR) has proven effective and economical for patients with gastric submucosal tumors (SMTs), showing great prospects. However, the poor operative field of view, the risk of tumors falling into the peritoneal cavity, especially the difficulties in defect closure, have limited its widespread application. Herein, we described a modified traction‐assisted Eo‐EFTR technique aimed at simplifying both the dissection and defect closure procedures. Methods Nineteen patients who underwent the modified Eo‐EFTR for gastric SMTs in the Chinese People's Liberation Army General Hospital were enrolled in the study. Following a 2/3 circumferential full‐thickness incision, a clip with dental floss was anchored to the resected part of the tumor surface. With the dental floss traction, the gastric defect was reshaped into a V shape, which facilitated the deployment of clips to close the defect. The defect closure and tumor dissection procedures were then performed alternately. Patients’ demographics, tumor characteristics, and therapeutic outcomes were evaluated retrospectively. Results All tumors had an R0 resection. The median procedure time was 43 min (range 28–89 min). No severe perioperative adverse events occurred. Two patients experienced transient fever, and three patients complained of mild abdominal pain on the first day after the operation. All patients recovered on the next day with conservative management. No residual lesion or recurrence was reported during the follow‐up period of 30.1 months. Conclusion The safety and practicability of the modified technique might allow for wide clinical applications of Eo‐EFTR in gastric SMTs. The modified exposed endoscopic full‐thickness resection (Eo‐EFTR) is performed as follows. After a 2/3 circumferential full‐thickness incision was performed along the tumor, the clip with dental floss is anchored to the resected part of the tumor surface and provides traction. With the traction of dental floss, the gastric defect presents a V shape that facilitates the deployment of the clips for defect closure. The closure of the defect and tumor dissection are then performed alternately.