Case Report: Endoscopic full-thickness resection using dual and IT knives for a false gastric diverticulum and systematic review.

Gastric diverticula are the rarest gastrointestinal diverticula, traditionally managed medically or surgically. We report a case of a long-standing gastric diverticulum with postprandial abdominal pain refractory to acid suppressive therapy for the past year, successfully treated by endoscopic full-thickness resection (EFTR). A 56-year-old woman presented with a 20-year history of postprandial left upper quadrant pain that had initially responded to proton pump inhibitors (PPIs) but became refractory over the past year. Repeated endoscopies revealed a gastric diverticulum with food impaction. She underwent EFTR for resection of the lesion. The postoperative course was uneventful, with no complications, and she recovered well. Postoperative histopathology confirmed a false gastric diverticulum lacking the muscular layer, with no evidence of neoplasia. At one month follow up, her abdominal pain had resolved, and endoscopy showed good healing of the resection site. This case suggests that EFTR is an effective treatment option for small, medication-refractory gastric diverticula. However, further studies are needed to define its optimal indications. Given the potential risk of coexisting neoplasia in false diverticula, more aggressive management and careful histopathological examination may be warranted.