Endoscopy 2012; 44 - A06
DOI: 10.1055/s-0032-1329279

Endoscopic full thickness resection of gastric subepithelial tumors (EndoResect Study)

C Schlag 1, D Wilhelm 1, S von Delius 1, H Feussner 1, A Meining 1
  • 1Adress available at: European Society of Gastrointestinal Endoscopy (ESGE), HG Editorial & Management Services, Mauerkircher Str. 29, 81679 Munich, Germany

Objective of the study: Endoscopic resection of gastric subepithelial tumors (SETs) bears a high risk of perforation. New techniques such as use of the OTSC®-clip may enable secure endoscopic closure of perforations but have not systematically been analysed. Hence, we aimed to evaluate the feasibility of endoscopic resection of small gastric SETs using a grasp-and-snare technique followed by OTSC®-closure of the gastric wall if necessary.

Methods and procedures: In this prospective study 20 patients who presented with small gastric SETs (= 3 cm) were enrolled. Endoscopic resection was performed using a double channel endoscope, a tissue anchor and a monofilament snare. If perforation occurred complete closure was aimed to be achieved with a tissue twin-grasper and the OTSC®-clip. Procedures were performed under laparoscopic control using a single port 5mm trocar placed through the umbilicus. All patients were followed up for 3 months after the procedure.

Results: In 6/20 patients a pure endoscopic approach was impossible and switch to laparascopic wedge resection was necessary (large tumor size in 2/6 patients; mainly extraluminal growth in 4/6 patients). Solely endoscopic resection was successfully performed in the remaining 14 patients. Amongst those, laparoscopic control was impossible due to severe adhesions in 2 cases. Perforation occurred in 6/14 patients and gastric closure with the OTSC®-clip was performed successfully in all these cases. No complications occurred and follow-up was unremarkable.

Conclusion: Endoscopic snare-resection of small gastric SETs (= 3 cm) seems to be a safe and minimal invasive procedure. Perforation can be adequately managed by placing the OTSC®-clip.