Post written by Abdullah Abbasi, MD, and Dennis Yang, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.

Exposed endoscopic full-thickness resection (EFTR) is often necessary for management of large subepithelial lesions or those extending deep into the GI wall. This video demonstrates successful removal of a large GI stromal tumor in the fundus, with a focus on our endoscopic approach to management of large peritoneal vessels.   

EFTR has emerged as an alternative to surgery for select cases of GI stromal tumors. Although observation data suggest that exposed EFTR is a safe technique in expert hands, this procedure presents several challenges. Notably, despite recent advances in endoscopy, our toolbox for prevention and management of large vessels remains limited.

Exposed EFTR is an organ-preserving intervention for select subepithelial lesions. However, challenges of endoscopic resection of these lesions include the risk of potentially life-threatening bleeding when encountering large vessels. In this video, we share pre-emptive endoscopic hemostatic strategies when encountering large vessels while using currently available devices and accessories. In the ever-expanding field of therapeutic endoscopy, there is a need for the ongoing development of novel endoscopic devices and techniques to support safe and efficient management of these GI diseases.

A, Endoscopic view of large peritoneal feeding vessels identified during endoscopic resection of the GI stromal tumor. B, Endoscopic clips were placed on the vessel to exert mechanical tamponade. C, Once the vessel was ligated by placement of several endoscopic clips, the vessel was transected using the coagulation grasper.

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