Endoscopy 2022; 54(06): E273-E274
DOI: 10.1055/a-1508-5241
E-Videos

Endoscopic resection of a rectal gastrointestinal stromal tumor using the submucosal tunneling endoscopic resection (STER) technique

Timothée Wallenhorst
1   Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
,
Jérémie Jacques
2   Department of Hepatogastroenterology, Centre Hospitalier Universitaire Dupuytren, Limoges, France
,
Astrid Lièvre
1   Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
,
Mael Pagenault
1   Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
,
Guillaume Bouguen
1   Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
,
Mathieu Pioche
3   Department of Gastroenterology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Charlène Brochard
1   Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
› Author Affiliations

The optimal treatment for a gastrointestinal stromal tumor (GIST) of the rectum is controversial owing to its extremely low incidence [1]. The submucosal tunneling endoscopic resection (STER) technique is a so-called “nonexposed” full-thickness endoscopic resection technique developed to remove upper gastrointestinal submucosal tumors (SMTs) arising from the muscularis propria [2] [3]. This technique allows a very interesting exposure of a GIST, as the axis of the knife is more tangential than when using an “exposed ESD technique”, which features a perpendicular axis that carries a risk of R1 resection. We believe that it could also be interesting for the resection of rectal SMTs. We report here the first successful use of this technique, with an accompanying video ([Video 1]), for the removal of a 15-mm rectal GIST.

Video 1 Endoscopic resection of a rectal gastrointestinal stromal tumor using the submucosal tunneling endoscopic resection (STER) technique.


Quality:

A 59-year-old woman was referred for endoscopic resection of a lower rectal SMT. The lesion had been discovered incidentally during a screening colonoscopy. Endoscopic ultrasound confirmed a rectal SMT arising from the muscularis propria.

The STER procedure was performed using a DualKnife, starting the submucosal tunnel 3 cm upstream of the lesion. After releasing the submucosa around the tumor within this tunnel, we made a circumferential muscular incision in the healthy margin ([Fig. 1]). We then carried out complete enucleation, while preserving the external muscular layer. The lesion was removed from the submucosal tunnel using tripod forceps. The tunnel entrance was closed with five 16-mm clips.

Zoom Image
Fig. 1 Endoscopic view during submucosal tunneling endoscopic resection (STER) of a rectal gastrointestinal stromal tumor, which allows an interesting exposure of the lesion within the tunnel, particularly while making the muscular incision in the healthy margin.

Histopathological analysis showed complete resection of a 15-mm GIST, with a mitotic index of 14 mitoses per 5 mm2, corresponding to a lesion at high risk of recurrence [4]. Molecular analysis showed the presence of a KIT exon 1 mutation. A multidisciplinary consultation meeting proposed giving an adjuvant treatment with imatinib [5].

The STER technique seems feasible in the rectum and helpful to facilitate complete R0 resection of rectal GISTs. This technique allows an interesting exposure of the GIST, particularly while making the muscular incision in the healthy margin.

Endoscopy_UCTN_Code_TTT_1AO_2AG

Endoscopy E-Videos
https://eref.thieme.de/e-videos

Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos



Publication History

Article published online:
18 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany