{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T13:11:51Z","timestamp":1788527511542,"version":"build-2803163510"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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\u2005cm. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1936608","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:12:02Z","timestamp":1788523922000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Cross-overlapping multi-purse-string closure of a large gastric wall defect after endoscopic full-thickness resection"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhiyu","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]},{"name":"Yunnan Provincial Clinical Medical Center for Digestive System Diseases","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]},{"name":"Yunnan Provincial Clinical Medical Center for Digestive System Diseases","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialong","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]},{"name":"Yunnan Provincial Clinical Medical Center for Digestive System Diseases","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]},{"name":"Yunnan Provincial Clinical Medical Center for Digestive System Diseases","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Third People's Hospital of Yunnan Province","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"He","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]},{"name":"Yunnan Provincial Clinical Medical Center for Digestive System Diseases","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zan","family":"Zuo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]},{"name":"Yunnan Provincial Clinical Medical Center for Digestive System Diseases","place":["Kunming, China"]},{"name":"Yunnan Provincial Key Laboratory of Clinical Virology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3293","DOI":"10.1007\/s00464-022-09801-x","article-title":"Endoscopic full-thickness resection for upper gastrointestinal tract lesions: a systematic review and meta-analysis","volume":"37","author":"Abdallah","year":"2023","journal-title":"Surg Endosc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1080\/17474124.2024.2357611","article-title":"Endoscopic full thickness resection: techniques, applications, outcomes","volume":"18","author":"Nabi","year":"2024","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1055\/a-1222-3191","article-title":"Diagnosis and management of iatrogenic endoscopic perforations: european society of gastrointestinal endoscopy (ESGE) position statement - 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