Endoclip and snare combined traction and resection for treating gastric submucosal tumor with extraluminal growth

Endoscopic resection of extraluminal gastric submucosal tumors is technically demanding due to their location outside the gastric lumen, which often limits visualization and access. Conventional endoscopic techniques often fall short in addressing these challenges, frequently requiring traction-assisted innovative methods to ensure safe and complete resection [1] [2] [3] [4]. We describe a novel method using a combined endoclip and snare to perform endoscopic full-thickness resection (EFTR), successfully completed in approximately 60 minutes.

A 60-year-old female patient presented with epigastric discomfort. Computed tomography scanning revealed a 3.5 × 2.5 cm extraluminal mass located along the greater curvature of the stomach ([Fig. 1]). Endoscopic examination identified a hemispherical submucosal bulge in the upper gastric body. Given the lesion's substantial size, symptomatic presentation, and potential malignant risk, EFTR was indicated. The procedure was conducted under general anesthesia with endotracheal intubation in a standard endoscopy suite, which involved four steps ([Video 1]). A full-thickness incision was made adjacent to the tumor using a DualKnife ([Fig. 2] a), creating an opening adequate for tumor passage. An endoclip was deployed to grasp and pull the tumor into the gastric lumen, forming an artificial pseudopedicle ([Fig. 2] b). A snare was placed securely around the base of this pseudopedicle ([Fig. 2] c). The lesion was resected by cutting along the snare, and the resultant gastric wall defect was carefully closed using multiple endoclips ([Fig. 2] d). Histopathology confirmed schwannoma, with spindle cells on H&E ([Fig. 3] a) and positive SOX10/S-100 immunostaining ([Fig. 3] b, [Fig. 3]c).

Fig. 1 Preoperative computed tomography image showing a 3.5 × 2.5 cm extraluminal mass (arrow) along the greater curvature of the stomach.

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Demonstration of endoscopic procedure.Video 1

Fig. 2 Endoscopic procedure steps for full-thickness resection of the extraluminal gastric submucosal tumor. a Full-thickness incision made adjacent to the tumor. b An endoclip was used to grasp and retract the tumor into the gastric lumen, forming an artificial pseudopedicle. c A snare was positioned around the base of the pseudopedicle. d The gastric wall defect was closed with multiple endoclips after resection.

Fig. 3 Histopathological results of the resected gastric lesion. a Hematoxylin and eosin (H&E) staining reveals a typical proliferation of spindle-shaped tumor cells. b Immunohistochemical stain for SOX10. c Immunohistochemical stain for S-100.

This endoclip-snare traction technique advances management of extraluminal gastric submucosal tumors. By enabling effective traction and stabilization of the tumor, the method facilitates safe resection and simplifies closure, thereby overcoming a major limitation of conventional EFTR. It shows promise for broader application in resection of similarly challenging lesions and underscores the value of instrumental innovation in advancing endoscopic surgery.

Contributorsʼ Statement

Jia Xu: Formal analysis, Resources, Visualization, Writing - original draft, Writing - review & editing. Zhouyue Zhang: Writing - original draft. Muhan Lü: Supervision. Xiaowei Tang: Conceptualization, Data curation, Funding acquisition, Methodology, Project administration, Resources, Supervision, Writing - review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Liu X, Chen T, Cheng J. et al. Endoscopic transmural route for dissection of gastric submucosal tumors with extraluminal growth: experience in two cases. Gut 2021; 70: 2052-2054
• 2 Hu Y, Huang L, Hu K. et al. Gastric submucosal tumor with extraluminal growth: successful resection with transgastric natural orifice transluminal endoscopic surgery. Endoscopy 2023; 55: E26-E28
• 3 Ma L-Y, Guo K-Y, Liu X-Y. et al. Efficacy and safety of endoscopic intraperitoneal subserosal dissection for gastric submucosal tumors with extraluminal growth pattern. Endoscopy 2025; 57: 1261-1267
• 4 Chen T, Zhang YW, Lian JJ. et al. No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors. Endoscopy 2023; 55: 557-562

Publication History

Received: 17 October 2025

Accepted after revision: 04 December 2025

Article published online:
22 January 2026