LAUSR

Deep ulcers and even perforations can occur after endoscopic submucosal enucleation (ESE) of gastrointestinal submucosal tumors (SMTs), as most SMTs arise from the muscularis propria layer. If SMTs can be removed by ESE without damaging the overlying normal mucosa, the defects can be completely closed with the remaining normal mucosa. Recently, countertraction has been reported to facilitate resection of gastrointestinal SMTs [1]. In this report, we describe how to use a clip-with-line (CWL) method to facilitate enucleation of an SMT, with the entire overlying normal mucosa preserved to close the defect completely after ESE. A 30-year-old man was admitted to our hospital because of dyspepsia. A gastric SMT was detected endoscopically (▶Fig. 1). Subsequently, endoscopic ultrasound was used to show that the SMT originated in the muscularis propria layer (▶Fig. 2). At the patient’s express request, ESE was performed; written informed consent was obtained before treatment. First, after marking and submucosal injection, a semicircumferential mucosal incision was created using a DualKnife from Olympus (Tokyo, Japan). Submucosal dissection exposed the SMT E-Videos