This is a case of early gastric cancer in the fundus of the stomach. Treatment was provided with endoscopic submucosal dissection (ESD), which is typically quite challenging in this location.

We used a combination of a multi-bending scope and line-and-sheath traction to create safe and efficient views. Dissection progressed in the forward view, and the lesion was ultimately resected en bloc. Final histology showed an R0 resection of an early gastric adenocarcinoma (pT1a).

Often, attempts are made to perform ESD in this location in retroflexion, but this usually causes the muscle to be directly perpendicular to the knife, risking deep injury. This method allowed us to create safer views parallel to the muscle layer. Moreover, the procedure was completed in forward view, which some find to be a more natural scope orientation.

During ESD in the fundus, similar to other difficult locations, it is important to know what tools and techniques one has at their disposal to facilitate the procedure. The most effective technique likely differs with patient factors, exact lesion location, and endoscopist preference. Nonetheless, we think the cliff descending method can be a strong candidate when planning for ESD in the gastric fundus.

We thank VideoGIE for the opportunity to present this video case.

A, Specimen after resection. B, Neoplastic areas of the specimen. C (H&E, orig. mag. ×0.4) and D (H&E, orig. mag. ×5), Histopathology showing adenocarcinoma without muscular invasion.