Balloon occlusion method using a commercially available ileus tube during endoscopic full-thickness resection: Simple solution to gas leakage

Introduction

One of the major challenges in performing endoscopic full-thickness resection (EFTR) for gastric submucosal tumors is leakage of intragastric gas into the abdominal cavity through the full-thickness defect [1]. Previous solutions have ingeniously included handmade balloon devices [2]. However, this approach can be time-consuming, and the handmade nature of the balloon introduces potential risks such as rupture, intraperitoneal dislodgement, and unintentional detachment during the procedure. We report a case in which EFTR was successfully completed while maintaining a stable endoscopic field by using a balloon occlusion method with a commercially available ileus tube (EFTR balloon) inserted into the full-thickness defect.

Case report

A 58-year-old man had a progressively enlarging 20-mm submucosal tumor in the greater curvature of the upper gastric body, diagnosed as a fourth-layer gastrointestinal stromal tumor, for which EFTR was performed. After mucosal incision around the lesion, the tumor was grasped and traction was applied. Dissection was carefully performed under direct visualization of the serosal layer, resulting in minimal full-thickness resection. Even when we attempted the procedure, the defect tended to enlarge, and the abdominal cavity tissues became visible in the background ([Fig. 1] a). Tumor resection was performed as promptly as possible. Gas leakage resulted in collapse of the gastric lumen, thereby hindering closure ([Fig. 2] a). Due to increased intra-abdominal pressure, an abdominal puncture was performed. An EFTR balloon ([Fig. 1] b) then was inserted through the defect and inflated within the abdominal cavity. Gentle traction on the tube secured its position ([Fig. 1] c), allowing adequate gastric lumen expansion and stable endoscopic visualization ([Fig. 2] b), and defect closure was performed. By pulling the balloon and placing a stay suture, easy closure near the balloon can be achieved. After deflating and removing the balloon, the defect was completely closed with endoscopic clips ([Video 1]).

Fig. 1 Figure showing balloon occlusion method using a commercially available ileus tube during endoscopic full-thickness resection. a Dissection was carefully performed under direct visualization of the serosal layer, resulting in minimal full-thickness resection. Even when we attempted the procedure, the defect tended to enlarge, and the abdominal cavity tissues became visible in the background. b A commercially available ileus tube (EFTR balloon: Long Intestinal Tube TYPE CP-II Single balun; Create Medic Co., Ltd. Kanagawa, Japan). c An EFTR balloon was then inserted through the defect and inflated within the abdominal cavity and gentle traction on the tube secured its position.

Fig. 2 Schema of balloon occlusion method using a commercially available ileus tube. a Gas leakage led to collapse of the gastric lumen, thereby hindering continuation of the procedure. b The tube was gently pulled to secure the position and this allowed for adequate expansion of the gastric lumen and stable endoscopic visualization.

Video herunterladen

Video showing balloon occlusion method using a commercially available ileus tube during endoscopic full-thickness resection.Video 1

Contributorsʼ Statement

Haruhiro Inoue conceived the study. Satoshi Abiko drafted the manuscript. Kei Ushikubo, Kazuki Yamamoto, Yohei Nishikawa, Ippei Tanaka and Naoya Sakamoto revised the manuscript. All authors were involved in critical revision of the manuscript for important intellectual content.

Conflict of Interest

Author Haruhiro Inoue is an advisor for Olympus Corporation and Top Corporation. He has also received educational grants from Olympus Corporation and Takeda Pharmaceutical Co. The other authors declare no conflicts of interest for this article.

Acknowledgement

We thank Yuta Tamaru, Kohei Shigeta, Mayo Tanabe, Nikko Theodore Valencia Raymundo, and Manabu Onimaru in the Digestive Diseases Center, Showa Medical University Koto Toyosu Hospital, for his kind support and advice. We are very grateful to the wonderful staff in the endoscopic room, outpatient care, and ward of Showa Medical University Koto Toyosu Hospital.

• 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 Aslan F, Ozer S, Taskin OC. et al. Challenges and solutions in endoscopic full-thickness resection. VideoGIE 2025; 10: 289-295

Publikationsverlauf

Eingereicht: 07. August 2025

Angenommen nach Revision: 03. Oktober 2025

Artikel online veröffentlicht:
03. November 2025