ArticleFrontiers in medicine2026
Case Report: Cross-overlapping multi-purse-string closure of a large gastric wall defect after endoscopic full-thickness resection.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Secure endoscopic closure of large gastric full-thickness defects after endoscopic full-thickness resection (EFTR) remains challenging, particularly when the defect is irregular and dedicated closure devices are unavailable or unsuitable. Case presentation: A 63-year-old man underwent EFTR for a 4.5-cm gastric body lesion originating from the muscularis propria. Resection created an irregular full-thickness defect of approximately 4 cm. Three nylon loops were independently anchored around the defect margin with metal clips using deliberately staggered, partially overlapping fixation paths. Sequential tightening created a cross-overlapping mesh-like configuration and achieved complete endoscopic closure. Air insufflation showed no leakage. Postoperative imaging demonstrated no significant free air or fluid accumulation, and histopathology confirmed a low-risk gastrointestinal stromal tumor. The patient was discharged on postoperative day 7. Endoscopic follow-up at 3, 6, and 12 months demonstrated progressive mucosal healing without reperforation or stenosis. Conclusion: Cross-overlapping multi-purse-string closure using conventional nylon loops and metal clips was feasible in this selected large and irregular gastric defect. The technique may offer a device-accessible option when standard single-loop closure is considered insufficient, although its reproducibility and comparative effectiveness require evaluation in larger studies.
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