Post written by Dennis Yang, MD, from the Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.
We present a case of a 60-year-old man with a 15-mm gastrointestinal stromal tumor (GIST) in the stomach. The patient elected for resection instead of surveillance. After multidisciplinary discussion, the decision was to proceed with endoscopic removal. The lesion was successfully removed enbloc with a dedicated over-the-scope clip-assisted endoscopic full-thickness resection (EFTR) device. Immediate post-resection bleeding was adequately managed using the coagulation grasper using soft coagulation mode. There were no delayed adverse events. Pathology revealed this to be a low-grade GIST, spindle cell type.
EFTR is increasingly being performed for the removal of selected subepithelial gastrointestinal (GI) lesions. Potential advantages of EFTR include its minimally invasiveness and ability to procure an adequate histopathological specimen to assess for malignant potential and when establishing curative resection. The over-the-scope clip-assisted EFTR device is a close and then cut technique that focuses on securing the defect before resection, thereby potentially reducing the risk of contamination by limiting exposure of the peritoneal cavity to bowel and luminal contents. The current system is approved for the management of colorectal lesions. Data on the safety and efficacy of this device in the upper GI tract is limited.
The use of this device in the upper GI tract is an off-label indication and should be discussed on a case-by-case basis or as part of clinical trials. Future prospective studies are needed to further evaluate its safety and efficacy in this setting.
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