Closing the defect after gastric endoscopic full-thickness resection with a novel closure device

Endoscopic full-thickness resection (EFTR) is a less invasive and a potentially effective treatment for gastrointestinal stromal tumors (GISTs).^{1, 2} Although various devices and suture methods have been reported for defect closure after EFTR,³ the current options are cumbersome. Recently, a new closure device (MANTIS Clip; Boston Scientific, Natick, MA, USA) has become available that can be rotated and reopened with a strong grasping force owing to the clip anchors. Its use has been reported in closing ulcers after endoscopic submucosal dissection and esophageal rupture.^{4, 5} We report a case in which combining this closure device and conventional endoclips (SureClip; Micro-Tech, Nanjing, China) was useful for closing a defect after EFTR.

A 64-year-old woman presented with a submucosal tumor in the lesser curvature of the middle gastric body on upper gastrointestinal endoscopy (Fig. 1a). Endoscopic ultrasound (EUS) revealed an 18 mm hypoechoic mass arising from the muscularis propria, which was histologically diagnosed as a GIST by EUS-guided fine needle aspiration biopsy. Subsequently, we performed EFTR for the GIST using an endoknife (ITknife 2; Olympus Medical, Tokyo, Japan) with traction devices under general anesthesia. Immediately after tumor removal (Fig. 1b), we employed the closure device (Fig. 1c, Video S1). The marginal mucosa of the defect was grasped, pulled toward the contralateral mucosa, and closed (Fig. 1d). The defect was closed with three closure devices (Fig. 1e), and the gap between the devices was closed using conventional endoclips placed close to the mucosa (Fig. 1f). Oral intake was initiated on postoperative day 2. She was discharged on postoperative day 6 without adverse events, such as delayed perforation or bleeding. The final histological diagnosis was a very low-risk GIST based on Fletcher's classification. This technique is simple, has a short closure time, and serves as an option for the closure of full-thickness defects after EFTR.

Authors declare no conflict of interest for this article.