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DOI: 10.1055/a-2471-7995
Endoscopic full-thickness resection with local injection into tissue outside the capsule of a gastrointestinal stromal tumor
Recently, the usefulness of endoscopic full-thickness resection (EFTR) of gastrointestinal stromal tumor (GIST) has been demonstrated [1] [2]. However, the R0 resection rate of endoscopy alone is problematic. We previously reported a method for achieving R0 resection during endoscopic muscularis dissection of an intraluminal growth type GIST using local injection of a hyaluronic acid solution into the muscle layer to attach the muscle layer to the tumor side using a knife capable of delivering the fluid [3]. In this report, we describe the first case of local injection of hyaluronic acid solution into tissue outside the GIST capsule to achieve R0 resection.
The patient was a 72-year-old woman with a 13-mm GIST underneath an early gastric tumor in the lesser curvature of the stomach ([Fig. 1], [Video 1]). We performed ESD for the early gastric cancer, followed by complete resection of the GIST using EFTR ([Fig. 2]).
Quality:
The defect after ESD for early gastric cancer was 65 mm, and the GIST was located beneath the muscle layer of the mucosal defect. First, the muscle layer around the tumor was incised. A clip with line was placed on the anal side of the normal muscle layer. Local injection into the tissue outside the GIST capsule resulted in blue staining of tissue away from the tumor to allow precise and complete dissection of the GIST. Even fatty tissues that are difficult to resect can be removed easily by local injection as electrolytes are injected into the tissues.
The pathological diagnosis was R0 resection and a very low-risk GIST. The muscle layer of the full-thickness defect was closed using the reopenable clip over-the-line method (ROLM) [4] [5]. The remaining mucosal defect was completely closed using ROLM. The patient was discharged 6 days after the procedure without any adverse events.
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Publication History
Article published online:
03 December 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Chen T, Zhang YW, Lian JJ. et al. No-touch endoscopic full-thickness resection technique for gastric gastrointestinal stromal tumors. Endoscopy 2023; 55: 557-562
- 2 Shichijo S, Abe N, Takeuchi H. et al. Endoscopic resection for gastric submucosal tumors: Japanese multicenter retrospective study. Dig Endosc 2023; 35: 206-215
- 3 Nomura T, Sugimoto S, Oyamada J. et al. Gastric endoscopic muscularis dissection using a partial intramuscular injection technique. Endoscopy 2023; 55: E209-E210
- 4 Nomura T, Sugimoto S, Fujimura Y. et al. Full-thickness defect closure using the reopenable clip over-the-line method with omental patch. Endoscopy 2023; 55: E969-E970
- 5 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip-over-the-line method for closing large mucosal defects following gastric endoscopic submucosal dissection: prospective feasibility study. Dig Endosc 2023; 35: 505-511