Endoscopy 2022; 54(05): E238-E239
DOI: 10.1055/a-1493-2004

Gastric subcentimeter subepithelial tumor: successful resection with an over-the-scope padlock clip

1   Endoscopy Center, Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
2   General Education Center, Chienkuo Technology University, Changhua, Taiwan
3   Department of Electrical Engineering, Chung Yuan Christian University, Chung Li, Taiwan
Hui-Ting Hsu
4   Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan
› Author Affiliations
Supported by: Changhua Christian Hospital, http://dx.doi.org/10.13039/501100007632
Supported by: 109-CCH-IRP-008

A 60-year-old woman was referred for endoscopic resection of two 5-mm gastric subepithelial lesions ([Fig. 1]) incidentally found during a screening endoscopy. Abdominal computed tomography (CT) revealed no lesions. The lesions were hypoechoic and originated from the muscle layer on endoscopic ultrasonography and were undetected on the endoscopy performed 5 years before. Follow-up was advised owing to the small lesions, but the patient requested an endoscopic resection to further clarify the nature of the tumor.

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Fig. 1 Endoscopic view of the gastric subepithelial lesions. Left: middle body posterior wall. Right: gastric cardia.

Endoscopy was performed after coagulation marking on the lesion ([Fig. 1], right). Two padlock clips (Steris, Mentor, Ohio, USA) were placed after suction of the targeted lesions ([Fig. 2], left). The lesion with the overlying mucosa was removed using single-step hot snare resection ([Fig. 2], right; [Video 1]). Both tumors were completely resected ([Fig. 3]). Abdominal radiography revealed no perforation ([Fig. 4]). The patient received a restricted diet and was discharged the next day. Pathological examination revealed that the lesion from the gastric cardia was a gastrointestinal stromal tumor [CD 117 (+), Dog1 (+), CD 34 (+), desmin (−), and S-100(−)] and the other one from the body was a leiomyoma [CD 117 (−), Dog1 (−), CD 34 (−), desmin (+), and S-100 (−)].

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Fig. 2 Endoscopic view of the resection process. Left: ligation of the lesion with a padlock clip. Right: endoscopic view after resection of the tumor.

Video 1 Successful resection of gastric subcentimeter subepithelial tumor with an over-the-scope padlock clip.

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Fig. 3 Endoscopic view of the resected specimen. Left: body. Right: gastric cardia.
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Fig. 4 Abdominal X-ray after placement of two padlock clips.

A subepithelial lesion of the stomach is a common incidental finding during endoscopy especially for lesions < 2 cm in size [1] [2]. Surveillance endoscopy is recommended owing to the low risk of disease progression, but patient compliance is poor [3]. Leiomyoma and gastrointestinal stromal tumor (GIST) are the two leading causes of subepithelial lesions arising from the muscle layer. While leiomyomas are almost benign, larger GISTs have a malignant potential. Endoscopic or radiological differentiation of the two conditions is difficult as demonstrated in this case. Several endoscopic resection techniques were proposed for such lesions but are technically demanding [1], with a high perforation risk. This case demonstrates the usefulness of over-the-scope clips [4] as an easy treatment method for small subepithelial lesions.


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Publication History

Publication Date:
08 June 2021 (online)

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