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DOI: 10.1055/a-2638-5906
The hidden danger behind a normal endoscopy: successful endoscopic full-thickness resection guided by endoscopic ultrasound
Supported by: Project of “CMC Talents” Peak Plan of Chengdu Medical College Innovation Research Team Project
A 38-year-old man underwent abdominal computed tomography (CT) during routine health screening, which revealed a linear hyperdense structure near the lesser curvature of the gastric antrum ([Fig. 1]). He recalled ingesting a fish bone 2 months earlier but experienced no significant discomfort at the time and did not seek medical attention. Initial upper endoscopy showed no mucosal abnormalities ([Fig. 2]). Endoscopic ultrasound (EUS) localized the foreign body within the deep muscularis propria ([Fig. 3]). EUS-guided methylene blue injection and titanium clip placement were performed to guide endoscopic submucosal dissection, exposing the muscularis layer. Despite adequate dissection, the fish bone remained invisible, likely due to chronic inflammation and fibrosis resulting in transmural incorporation and concealment ([Fig. 4]). Real-time EUS was re-employed for precise re-localization, followed by a deeper incision. The foreign body was tightly adherent to the gastric wall and could not be removed with forceps. A snare was used to anchor and provide countertraction, while a mucosal incision knife facilitated meticulous dissection of the fibrotic base. This coordinated traction–dissection approach enabled successful full-thickness endoscopic resection, retrieving a 3-cm fish bone ([Fig. 5]). The defect was closed with titanium clips ([Video 1]). This case highlights that fish bone ingestion warrants careful evaluation even where endoscopy findings are normal; additional imaging such as CT and the dynamic benefits of EUS play crucial roles.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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Publication History
Article published online:
14 July 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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