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

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.

Zoom Image
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 (−)].

Zoom Image
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.


Quality:
Zoom Image
Fig. 3 Endoscopic view of the resected specimen. Left: body. Right: gastric cardia.
Zoom Image
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.

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


#

Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Hsu-Heng Yen, MD
Division of Gastroenterology
Changhua Christian Hospital
135 Nanhsiao St.
Changhua 500
Taiwan   

Publication History

Publication Date:
08 June 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Endoscopic view of the gastric subepithelial lesions. Left: middle body posterior wall. Right: gastric cardia.
Zoom Image
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.
Zoom Image
Fig. 3 Endoscopic view of the resected specimen. Left: body. Right: gastric cardia.
Zoom Image
Fig. 4 Abdominal X-ray after placement of two padlock clips.