ENDOSCOPIC WEDGE GASTRECTOMY OF A SUBEPITHELIAL TUMOR WITH CLOSURE OF THE GASTRIC WALL DEFECT WITH OVERSTITCH ENDOSCOPIC SUTURING SYSTEM

A 51-year-old woman affected by gastric submucosal tumors (Fig. 1) underwent an EUS. Echographic imaging showed a homogeneous, hypoechoic lesion on the front wall of the gastric body, starting at the fourth layer of the wall, of about 22 mm in diameter (Fig. 2). The histological examination of the EUS-guided fine needle aspiration biopsy found a gastrointestinal stromal tumor (GIST).

The actual size of the GIST with respect to the previous examination indicated resection, which remains the only modality that can offer a permanent cure of GISTs, and avoid tumor rupture and injuries to the pseudocapsule.

The resection was performed using an O-type HybridKnife (Erbe Elektromedizin, Germany).

The excision resulted in a complete gastric wall defect (about 4 × 4 cm in length) (Fig. 3), which was closed with over-the-scope endosutures (Fig. 4). The OverStitch Endoscopic Suturing System (Apollo Endosurgery, USA) enables placement of full-thickness sutures through a flexible dual channel endoscope (GIF2T160 Olympus Europe, Germany) and repair of the defect (Fig. 5). We performed the entire procedure inflating Carbon Dioxide in about 140 minutes.

Full-thickness endoscopic suturing for management of defects appears to be safe and efficacious, and also seems to be useful for promoting the development of endoluminal surgery projected towards the peritoneum. Further investigation is needed to clarify what place this device will occupy in endoscopic equipment.

Legends:

Fig. 1: GIST (endoscopic view)

Fig. 2: GIST (EUS view)

Fig. 3: complete gastric wall defect after resection

Fig. 4: suturing the gastric defect

Fig. 5: repaired gastric wall defect

Video: Endoscopic Wedge Gastrectomy of a Subepithelial Tumor with Closure of the Gastric Wall Defect with Overstitch Endoscopic Suturing System