Case Report: Cross-overlapping multi-purse-string closure of a large gastric wall defect after endoscopic full-thickness resection.

BACKGROUND: Secure endoscopic closure of large gastric full-thickness defects after endoscopic full-thickness resection (EFTR) remains challenging, particularly when the defect is irregular and dedicated closure devices are unavailable or unsuitable. CASE PRESENTATION: A 63-year-old man underwent EFTR for a 4.5-cm gastric body lesion originating from the muscularis propria. Resection created an irregular full-thickness defect of approximately 4 cm. Three nylon loops were independently anchored around the defect margin with metal clips using deliberately staggered, partially overlapping fixation paths. Sequential tightening created a cross-overlapping mesh-like configuration and achieved complete endoscopic closure. Air insufflation showed no leakage. Postoperative imaging demonstrated no significant free air or fluid accumulation, and histopathology confirmed a low-risk gastrointestinal stromal tumor. The patient was discharged on postoperative day 7. Endoscopic follow-up at 3, 6, and 12 months demonstrated progressive mucosal healing without reperforation or stenosis. CONCLUSION: Cross-overlapping multi-purse-string closure using conventional nylon loops and metal clips was feasible in this selected large and irregular gastric defect. The technique may offer a device-accessible option when standard single-loop closure is considered insufficient, although its reproducibility and comparative effectiveness require evaluation in larger studies.