Zipper endoscopic full-thickness resection: a pilot study in subepithelial tumor management (with video).

Background And Aims: Traditional endoscopic full-thickness resection (EFTR) involves complete removal of the lesion followed by defect closure. The separated resection and closure technique results in mucosal eversion and misalignment of the muscularis propria layers, making reliable closure difficult. Here, we developed an innovative "cut-and-seal-as-you-go" technique, "Zipper-EFTR" and evaluated the feasibility and safety of the new technique.

Materials And Methods: We prospectively enrolled 15 patients with gastric subepithelial tumors resected by Zipper-EFTR. The primary outcome was the technical success rate. Secondary outcomes included the incidence of adverse events, procedure duration, and length of postprocedural hospital stay.

Results: The median maximum size of the lesions was 1.2 cm (range, 0.6-2.0), with 10 lesions in the fundus and 5 in the corpus. All lesions were successfully resected by Zipper-EFTR, and no patient developed fever or severe abdominal pain or other serious adverse events, such as perforation, bleeding, and abdominal abscess. The en bloc resection rate was 100% and the median procedure duration was 25 min (range, 20 -60). All patients were discharged safely with a median length of postprocedural hospital stay of 3 days (range, 2-4).

Conclusion: The Zipper-EFTR is a simple, safe, and easy-to-use technique for gastric subepithelial tumors.