Shashideep Singhal, MD, from the University of Texas Health Science Center in Houston, Texas describes this video case “Over-the-scope clip-assisted endoscopic resection of gastric submucosal nodule.”
A 61-year-old woman with refractory dyspepsia underwent upper endoscopy, which showed an incidental gastric submucosal nodule. EUS showed a 1.4-cm nodule arising from the muscularis propria. FNA results were inconclusive. We performed an over-the-scope clip (OTSC)-assisted endoscopic resection of a gastric submucosal nodule. The nodule was suctioned into the cap, and a 12/6 gc OTSC was placed over the nodule. The nodule was removed by use of a hot snare over the OTSC, which was left in place.
Gastric submucosal nodules are common incidental findings during an upper endoscopy. The management options are: EUS with FNA for diagnosis which is often limited by ability to determine malignant potential. Continued surveillance is practiced in lesions with low malignant potential and surgical resection for high-risk nodules. Both approaches involve significant anxiety and morbidity due to repeat procedures and risks associated with surgical procedures.
Endoscopic resection is a safe single step procedure for management of small gastric submucosal nodules with accurate tissue diagnosis, determination of malignant potential and potentially curative.
OTSC selection is important and is based on the size of nodule.
Biopsy of the base can be done after resection and send in a separate specimen container to confirm complete resection as cautery artifact can sometimes limit pathological assessment of margins in resected specimen.
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