Resected specimen extraction using a medical glove in endoscopic submucosal dissection of a large gastric submucosal tumor (with video)

A 64-year-old woman was admitted with a gastric submucosal tumor in the anterior wall of the fundus near the cardia (A). EUS showed a heterogeneously hypoechoic mass (2.8 cm) originating from the muscularis propria. Considering that it was an intraluminal growth type with a small risk of perforation, we opted for endoscopic submucosal dissection (ESD) without any procedure-related event. We attempted to extract the specimen using a snare but failed. We then decided to use a medical glove to hold the tumor, so that not only could greater force be used to pull the tumor out, but all the tissue could be collected. Briefly, the glove was brought into the stomach by use of a snare. Foreign body forceps were then used to position and enlarge the opening of the glove so that the specimen could be loaded smoothly. After the tumor was loaded, the glove was shaken with the forceps to allow the tumor to penetrate deeper into the glove (B). We then substituted the forceps for the snare to grasp and tighten the opening of the glove and slowly removed the entire specimen (C, D). Pathologic examination confirmed that the lesion was a GI stromal tumor. Thus, the use of a medical glove for large resected specimen extraction not only is cost effective but also allows complete removal of the tumor and prevention of tumor implantation (Video 1, available online at www.giejournal.org).