A 74 y old lady has referred with complain of upper GI discomfort, anorexia and gastric pain after eating. Based on her problems, an upper series requested which revealed the whole stomach herniated to the chest cavity (figure 1). Because of several comorbidities and old age, she was not a candidate for surgical reduction, so she planned for endoscopic reduction.

During endoscopy, the most difficult and important stage as first step is to find the gastric outlet which could be time consuming. Then the endoscopic should try to move the scope forward toward second and preferentially third part of the duodenum with a spiral movement like motorized enteroscope. After that, the scope should pull back while rotating clockwise. Sometimes it is necessary to repeat the maneuver twice or 3 times to achieve the best result. Immediately after the procedure, the patient feeling good and all of the pains and discomforts disappear.

Upside down stomach or total gastric herniation is a potentially dangerous condition specially among those with extreme age old and several comorbidities which could be reduced by upper endoscopy.