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DOI: 10.1055/a-2523-2684
A treatment option for rectal gastrointestinal stromal tumor: endoscopic submucosal dissection combined with endoscopic hand-suturing
Supported by: CAMS Innovation Fund for Medical Sciences (CIFMS) 2021-I2M-1-013, 2021-I2M-1-015, 2021-I2M-1-061, 2022-I2M-C&T-B-054
Supported by: Sanming Project of Medicine in Shenzhen SZSM201911008
Supported by: Capital’s Funds for Health Improvement and Research CRF2020-2-4025
Rectal gastrointestinal stromal tumors (GISTs) are very rare, accounting for about 5% of all GISTs [1]. Treatment for a rectal GIST should be carefully selected to avoid postoperative complications and impairment of anal sphincter function [2] [3]. Recently, several cases of endoscopic resection for rectal GISTs have been reported, but there is a lack of reports on strategies for defect closure [4] [5]. We report a novel method for treating a rectal GIST via a combination of endoscopic hand-suturing (EHS) with endoscopic submucosal dissection (ESD).
A 64-year-old man presented to our center with a rectal mass located 3 cm from the anal verge. Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) identified a submucosal tumor measuring 1.2 × 1.0 cm in the lower rectum ([Fig. 1]). After a multidisciplinary discussion, the tumor was considered to be a rectal GIST. Subsequently, having been fully informed of the condition and its associated risks, the patient chose to undergo ESD to treat the lesion and clarify the diagnosis.


The steps of ESD were performed strictly according to protocols and the tumor was removed en bloc ([Fig. 2] a, b). After resection, a significant depression was observed in the artificial ulcer, accompanied by damage to the muscularis propria layer ([Fig. 2] c). To prevent postoperative perforation, we performed endoscopic hand-suturing to close the defect and secured the suture tail with a clip after removing the needle ([Fig. 3]; [Video 1]). The ESD and endoscopic hand-suturing times were 51 and 53 minutes, respectively. The patient was discharged on postoperative day 4, without any adverse events having occurred. Histology confirmed that the tumor was a very low risk GIST and had been completely resected. Colonoscopy during the third postoperative month showed a healed scar without any signs of recurrence ([Fig. 4]).






Quality:
The use of ESD combined with endoscopic hand-suturing for treatment of a rectal GIST has not been previously reported. The application of endoscopic hand-suturing in this case successfully avoided postoperative adverse events, demonstrating the safety and feasibility of this novel method for treating rectal GISTs.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005; 100: 162-168
- 2 Kim SJ, Jung Y, Hong R. et al. Successful endoscopic resection of a rectal gastrointestinal stromal tumor larger than 5 cm. Korean J Gastroenterol 2021; 78: 235-239
- 3 Kameyama H, Kanda T, Tajima Y. et al. Management of rectal gastrointestinal stromal tumor. Transl Gastroenterol Hepatol 2018; 3: 8
- 4 Ishida T, Furumatsu K, Kado T. Endoscopic submucosal dissection of a rectal gastrointestinal stromal tumor close to the dentate line. Dig Endosc 2020; 32: e49-e51
- 5 Mavrogenis G, Maurommatis E, Koumentakis C. et al. Submucosal tunneling endoscopic resection for rectal gastrointestinal stromal tumor. Endoscopy 2023; 55: E619-E620
Correspondence
Publication History
Article published online:
18 February 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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References
- 1 Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005; 100: 162-168
- 2 Kim SJ, Jung Y, Hong R. et al. Successful endoscopic resection of a rectal gastrointestinal stromal tumor larger than 5 cm. Korean J Gastroenterol 2021; 78: 235-239
- 3 Kameyama H, Kanda T, Tajima Y. et al. Management of rectal gastrointestinal stromal tumor. Transl Gastroenterol Hepatol 2018; 3: 8
- 4 Ishida T, Furumatsu K, Kado T. Endoscopic submucosal dissection of a rectal gastrointestinal stromal tumor close to the dentate line. Dig Endosc 2020; 32: e49-e51
- 5 Mavrogenis G, Maurommatis E, Koumentakis C. et al. Submucosal tunneling endoscopic resection for rectal gastrointestinal stromal tumor. Endoscopy 2023; 55: E619-E620







