Hybrid resection of GI stromal tumor with endoscopic submucosal dissection and the full-thickness resection device

Post written by Varun Angajala, MD, MS, and Ara Sahakian, MD, from the Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Angajala_photo

We are excited to share our hybrid resection technique for a gastric subepithelial lesion (SEL). We performed submucosal dissection to unroof and expose the surface of the lesion before turning to the Full-Thickness Resection Device (FTRD; Ovesco Endoscopy, Tuebingen, Germany). This device uses an over-the-scope clip to ensure closure of the gastric wall before full-thickness resection.

Our video article highlights recent advancements in endoscopic resection of gastric SELs. The FTRD offers certain technical advantages over other full-thickness resection techniques, including submucosal tunneling endoscopic resection and exposed endoscopic full-thickness resection. There is a scarcity of endoscopists with sufficient skill and expertise to perform such techniques.

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Although the FTRD is accessible and widely available in comparison, it lacks the flexibility and adaptability of needle-knife—based techniques and is limited to small lesions that can be feasibly grasped and pulled in their entirety into the cap of the device.

In our experience, the presence of overlying mucosa can sometimes lead to incomplete retraction of the underlying lesion and suboptimal resection. Prior unroofing with endoscopic submucosal dissection (ESD) may address these challenges by enabling direct manipulation of the lesion with the FTRD.

Using ESD (or EMR if expertise in ESD is not readily available) to unroof gastric SELs may aid in achieving complete resection with the FTRD. However, endoscopists should recognize that SEL margins are often positive upon histologic examination because they are essentially enucleated during full-thickness resection.

Hybrid resection with ESD and the FTRD may be an effective technique for complete resection of gastric GI stromal tumors and other SELs. Further studies are needed to assess the effectiveness of this hybrid technique.

Angajala_Sahakian_figureFull-Thickness Resection Device clip in appropriate position and exposed muscularis propria seen above the clip.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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