A 56-year-old woman presented for evaluation of a gastric body submucosal nodule.
She underwent endoscopic ultrasound, which revealed a hypoechoic lesion arising from
the muscularis propria that measured 21.8 × 17.9 mm in diameter. Fine-needle aspiration
demonstrated spindle cells positive for C-KIT and DOG-1, consistent with gastrointestinal
stromal tumor (GIST).
For management of the lesion, she elected to undergo an endoscopic full-thickness
resection (EFTR). The borders of the lesion were marked circumferentially. After injection
to create a submucosal space, the mucosa was incised using a hybrid knife. The submucosa
was exposed to identify the lesion. EFTR was performed after the lesion was fully
exposed ([Fig. 1], [Video 1]). As dissection continued, multiple large blood vessels were seen encasing the lesion.
There was significant bleeding, which was controlled using coagulation grasper forceps
and hemostatic clips. Although hemostasis was achieved, a decision was made to complete
the procedure via surgical resection given the multiple blood vessels encasing the
lesion.
Fig. 1 Accessing the submucosal space for endoscopic full-thickness resection.
Video 1 Robotic-assisted endoscopic full-thickness resection with inversion of lesion into
the stomach for removal.
The procedure was converted to a robotic-assisted EFTR ([Video 1]). The lesion was identified via robotic exposure. The GIST and previously placed
clips were excised with the aid of upper endoscopy and a vessel sealer. The lesion
was placed in the stomach, removed endoscopically, and the gastric defect was closed.
The final lesion measured 4.5 × 3.2 cm, which was larger than the size predicted initially
by endosonography.
EFTR has been described for management of subepithelial gastric tumors [1]
[2]. Bleeding during resection has been reported in up to 38.7 % of cases [3]. Endoscopic hemostasis is typically successful. However, gastroenterologists who
undertake EFTR must always be prepared for complicated procedures, which occasionally
require conversion to surgical resection. Laparoscopy has been previously demonstrated
to assist EFTR [4]. We demonstrate a successful case of robotic-assisted EFTR of a GIST.
Endoscopy_UCTN_Code_CPL_1AH_2AZ
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in gastroenterological endoscopy. All papers include a high quality video and all
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