Mucosal zipper endoscopic resection offers a novel option for the treatment of gastric submucosal tumors

Endoscopic full-thickness resection (EFTR) has become the mainstream endoscopic resection method for gastric submucosal tumors (SMTs). EFTR enables access to deeper lesions by intentionally creating a full-thickness defect, as opposed to relying on accidental perforation [1] [2]. Consequently, closure of the iatrogenic defect remains one of the most critical technical challenges associated with EFTR. Most existing techniques involve full-thickness clamping of the gastric wall, which hinders the spontaneous detachment of metal clips. Additionally, these techniques often require specialized instruments and involve complex procedures, resulting in increased material consumption and costs, which limits their widespread clinical application [3] [4] [5].

To overcome these limitations, we developed a novel technique called mucosal zipper endoscopic resection (MZER) ([Fig. 1], [Video 1]). MZER reduces wound closure time and minimizes the leakage of digestive fluids containing gastric bacteria, thereby reducing the risk of abdominal infection and shortening the healing time. Moreover, the “zipper-like” mucosal closure preserves the mucosal barrier, effectively preventing digestive fluid leakage and reducing the risk of delayed perforation. This is particularly advantageous in cases of leiomyomas, where full-thickness resection is often unnecessary, further emphasizing the benefit of MZER in retaining normal tissue. More importantly, MZER does not require specialized equipment or costly consumables, resulting in lower complication rates and reduced costs, thus significantly lessening the economic burden on patients.

Fig. 1 Mucosal zipper endoscopic resection of a gastric submucosal tumor. a Endoscopic view of the tumor located in the gastric fundus. b Precutting the mucosal layer, forming a longitudinal incision. c Separation and full exposure of the tumor. d En bloc resection of the tumor. e Endoscopic view after tumor removal. f Metal clips applied after aligning the mucosal edges. g Wound closure with four metal clips. h The excised tumor.

Mucosal zipper endoscopic resection performed for a submucosal tumor located in the gastric fundus.Video 1

In conclusion, MZER is a feasible, effective, and safe technique for the treatment of gastric SMTs. Further studies are needed.

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Contributorsʼ Statement

Zhenkai Luo: Conceptualization, Writing – original draft. Rongwei Ruan: Investigation, Project administration. Jiangping Yu: Data curation. Yuan-Han Zhao: Investigation, Resources. Yuanshun Liu: Data curation. Yujia Zhai: Visualization. Shi Wang: Project administration, Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

We express our sincere gratitude to Malou Ferro for his professional clipping help.

• References

• 1 Tada N, Kobara H, Nishiyama N. et al. Current status of endoscopic full-thickness resection for gastric subepithelial tumors: a literature review over two decades. Digestion 2023; 104: 415-429
• 2 Cai MY, Martin Carreras-Presas F, Zhou PH. Endoscopic full-thickness resection for gastrointestinal submucosal tumors. Dig Endosc 2018; 30 (Suppl. 01) 17-24
• 3 Zhang Y, Wang X, Xiong G. et al. Complete defect closure of gastric submucosal tumors with purse-string sutures. Surg Endosc 2014; 28: 1844-1851
• 4 Sharaiha RZ, Kumta NA, DeFilippis EM. et al. A large multicenter experience with endoscopic suturing for management of gastrointestinal defects and stent anchorage in 122 patients: a retrospective review. J Clin Gastroenterol 2016; 50: 388-392
• 5 Schlag C, Wilhelm D, von Delius S. et al. EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy 2013; 45: 4-11

Publication History

Article published online:
07 October 2025