Endoscopy 2022; 54(08): E439-E440
DOI: 10.1055/a-1625-2382
E-Videos

Endoscopic cutting-wave biopsy for submucosal tumors smaller than 20 mm

Shintaro Tominaga
Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
,
Makoto Kobayashi
Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
,
Akihiro Maruyama
Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
,
Motoyoshi Yano
Department of Gastroenterology, Yokkaichi Municipal Hospital, Mie, Japan
› Author Affiliations
 

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used for pathological diagnosis of submucosal tumors; however, no diagnostic method has become established for small lesions (≤ 20 mm) [1]. Boring biopsies have been performed for a long time, but when the tumor is small and hard, the forceps often slip and sufficient tissue cannot be collected. We devised a method called endoscopic cutting-wave biopsy for submucosal tumors (E-CWBS), which resects a portion of a tumor using hot biopsy forceps and cutting waves. We report here the results of E-CWBS followed by pathological examination in 15 cases of upper gastrointestinal submucosal tumor measuring less than 20 mm ([Fig. 1]; [Video 1]).

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Fig. 1 Endoscopic cutting-wave biopsy for submucosal tumors. The tumor is exposed and biopsy performed using hot biopsy forceps and cutting waves.

Video 1 Endoscopic cutting-wave biopsy for submucosal tumors performed on a 15-mm submucosal tumor. The patient was discharged the next day without any complications such as bleeding or perforation. The pathological result revealed leiomyoma.


Quality:

Using our method, we first removed the mucosa and connective tissue using forceps and cutting waves to completely expose the tumor body. Next, the tumor was visually confirmed directly, firmly grasped by slightly pushing the biopsy forceps, and the cutting wave was energized to perform partial excision of the tumor. To control bleeding, hemostasis was performed using forceps and coagulation waves, and after surgery the mucosal defect was closed with several endoscopic clips.

The pathological diagnosis rate resulting from these biopsies was eight out of ten in tumors sized between 10 mm and 20 mm and (equivalently) four out of five in tumors smaller than 10 mm ([Fig. 2]). This diagnosis rate is higher than that associated with the conventional method EUS-FNA [2] [3]. In three cases, the tumors could not be diagnosed because of heat denaturation; therefore, it was considered necessary to shorten the energization time to the extent possible.

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Fig. 2 The resected specimen has suffered no heat denaturation, and immunogenicity is maintained.

No complications such as postoperative bleeding, perforation, or infection were observed in any case ([Fig. 3]).

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Fig. 3 At endoscopic follow-up the following year, the wound is seen to be tightly closed.

E-CWBS for submucosal tumors smaller than 20 mm in size is considered a safe and useful tool for collection of sufficient tissue.

Endoscopy_UCTN_Code_TTT_1AO_2AC

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Shintaro Tominaga, MD
2-2-37, Shibata
Yokkaichi-shi
Mie
Yokkaichi 510-8567
Japan   

Publication History

Article published online:
17 September 2021

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Zoom Image
Fig. 1 Endoscopic cutting-wave biopsy for submucosal tumors. The tumor is exposed and biopsy performed using hot biopsy forceps and cutting waves.
Zoom Image
Fig. 2 The resected specimen has suffered no heat denaturation, and immunogenicity is maintained.
Zoom Image
Fig. 3 At endoscopic follow-up the following year, the wound is seen to be tightly closed.