CC BY 4.0 · Endoscopy 2025; 57(S 01): E167-E168
DOI: 10.1055/a-2523-2684
E-Videos

A treatment option for rectal gastrointestinal stromal tumor: endoscopic submucosal dissection combined with endoscopic hand-suturing

Lizhou Dou
1   Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Angshu Cai
1   Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Shibo Song
2   Endoscopy Center, Peking University First Hospital, Beijing, China (Ringgold ID: RIN26447)
1   Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Guiqi Wang
1   Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Shun He
1   Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
› Author Affiliations
Supported by: Beijing Hope Run Special Fund of Cancer Foundation of China LC2021A03
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.

Zoom Image
Fig. 1 The preoperative examination findings were: a on colonoscopy, a submucosal tumor (arrow) located 3 cm from the anal verge; b on magnetic resonance imaging, the tumor was found to be situated in the lower rectum without invasion of adjacent organs; c on endoscopic ultrasound, the tumor (arrow) was hypoechoic and measured 1.2 × 1.0 cm.

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]).

Zoom Image
Fig. 2 Endoscopic images during resection of a rectal gastrointestinal stromal tumor (GIST) by endoscopic submucosal dissection (ESD) showing: a dissection of the submucosa; b the tumor completely removed with the capsule remaining intact; c the defect after ESD, with accompanying damage to the muscularis propria layer.
Zoom Image
Fig. 3 Endoscopic images after the endoscopic submucosal dissection of the rectal lesion showing: a closure of the defect using an absorbable barbed suture with needle (VLOCL0803; Covidien, Mansfield, Massachusetts, USA) and a needle holder originally designed by our team (entrusted manufacturer: Vedkang, Jiangsu, China); b the suture tail secured with a clip after closure of the defect; c the appearance 3 days after closure of the defect by endoscopic hand-suturing.
Zoom Image
Fig. 4 Follow-up colonoscopic image 3 months after the procedure showing a well-healed defect with fibrotic scar formation.

Quality:
Closure of the defect, which showed muscularis propria damage, after complete removal of a rectal gastrointestinal stromal tumor by endoscopic submucosal dissection using endoscopic hand-suturing.Video 1

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.

Endoscopy_UCTN_Code_TTT_1AQ_2AK

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Conflict of Interest

The authors declare that they have no conflict of interest.

  • 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

Shun He, MD
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
17 Panjiayuan Nanli, Chaoyang District
Beijing, 100021
China   

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/).

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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

Zoom Image
Fig. 1 The preoperative examination findings were: a on colonoscopy, a submucosal tumor (arrow) located 3 cm from the anal verge; b on magnetic resonance imaging, the tumor was found to be situated in the lower rectum without invasion of adjacent organs; c on endoscopic ultrasound, the tumor (arrow) was hypoechoic and measured 1.2 × 1.0 cm.
Zoom Image
Fig. 2 Endoscopic images during resection of a rectal gastrointestinal stromal tumor (GIST) by endoscopic submucosal dissection (ESD) showing: a dissection of the submucosa; b the tumor completely removed with the capsule remaining intact; c the defect after ESD, with accompanying damage to the muscularis propria layer.
Zoom Image
Fig. 3 Endoscopic images after the endoscopic submucosal dissection of the rectal lesion showing: a closure of the defect using an absorbable barbed suture with needle (VLOCL0803; Covidien, Mansfield, Massachusetts, USA) and a needle holder originally designed by our team (entrusted manufacturer: Vedkang, Jiangsu, China); b the suture tail secured with a clip after closure of the defect; c the appearance 3 days after closure of the defect by endoscopic hand-suturing.
Zoom Image
Fig. 4 Follow-up colonoscopic image 3 months after the procedure showing a well-healed defect with fibrotic scar formation.