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A case of gastric gastrointestinal stromal tumor treated with no-touch endoscopic full-thickness resection technique using reopenable-clip over-the-line method
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Hitoshi Mori1,2,
Noriya Uedo1,
Satoki Shichijo1 |
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1Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 2Department of Gastroenterology, Nara Medical University |
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| With advances in endoscopic resection and wound closure techniques, endoscopic resection of gastric gastrointestinal stromal tumors (GIST) has evolved rapidly nowadays. However, concerns remain regarding the oncologic safety of this technique, particularly the risk of tumor injury and the adequacy of the resection margins. To address these problems, the no-touch endoscopic full-thickness resection (EFTR) technique has recently been proposed, in which the tumor is removed with a resection margin of 0.5-1.0 cm. A man in his seventies was diagnosed with a submucosal tumor (SMT) in the posterior wall of the upper gastric body. The lesion was over 2.0 cm in size and GIST was suspected, so the patient was referred to our hospital. The procedure consisted of the following steps: (1) Marking around the line skirting the SMT protrusion; (2) Circumferential mucosal incision outside the markings without submucosal injection; (3) Creation of the deep mucosal/ submucosal groove until surface of the muscularis propria. (4) Application of a clip and line traction to the anal side of the lesion; (5) Muscle incision from the anal side along the mucosal/submucosal groove; (6) Defect closure with reopenable-clip over the line method (ROLM); and (7) Lesion retrieval. The total procedure time was 67min. The patient was discharged uneventfully. Histological examination confirmed that the lesion was low risk GIST and resection margin was free. |
Index Term 1: ROLM
Index Term 2: no-touch EFTR
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