Endoscopic ultrasound-guided cutting of holes and deep biopsy for diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors using a novel vertical diathermic loop

Figure 1 Vertical electrode loop. A: The vertical electrode loop device; B: The loop is dragged into the sheath when not working; C and D: When working, the small loop that is vertically wielded to the end of the electric metal wire is pushed out of the sheath.

Figure 2 A case diagnosed with gastric linitis plastic. A: Endoscopic characteristics: thick and rigid gastric duplicature and a narrow cavity; B: The loop was placed on the targeted focus characterized by the obviously thick and rigid wall on the tumor, then the holes were cut; C: A biopsy forceps was poked into the holes to acquire the deep tissue samples under the guidance of EUS; D: The tissue specimen was then analysed histopathologically and shown to be gastric adenocarcinoma.

Figure 3 Results of pathology and immunohistochemistry of gastrointestinal stromal tumors and gastric lymphoma. A and B: The pathology characterized by spindle cells (HE, × 200) and immunohistochemistry showing positive CD117 staining proved the diagnosis of gastrointestinal stromal tumors (GIST); C and D: Increased and dispersively distributed lymphocytes (HE, × 400) with positive CD10 staining according to the immunohistochemistry results confirmed the diagnosis of gastric diffuse large B-cell lymphoma.