A 60-year-old woman was admitted to hospital for evaluation of symptomatic anemia.
Esophagogastroduodenoscopy revealed a submucosal gastric tumor in the antrum (Figure
[1]) and probing of this tumor with the tip of the biopsy forceps revealed that it had
a solid consistency. A Huibregtse needle-knife (Wilson-Cook, Winston-Salem, North
Carolina, USA) was then inserted into the working channel of a standard Olympus Q160
gastroscope (Olympus America, Melville, New York, USA). Once the needle-knife was
exposed, a linear incision was made on the center of the submucosal gastric tumor
(Figure [2]). The incision was performed by moving the up/down control of the endoscope handle,
and the depth of the incision was determined by exposing two-thirds of the needle
length and by advancing or retracting the shaft of the Huibregtse needle-knife catheter
from the endoscopic channel. After an incision 1.5 cm in length had been made (Figure
[3]), a biopsy forceps (Microvasive Inc., Natick, Massachusetts, USA) was placed in
the submucosal mass through the incision. The forceps was opened inside the submucosal
gastric tumor and six bites of submucosal tissue were obtained. Histology revealed
an adenocarcinoma that was most consistent with a metastatic colon cancer. Colonoscopy
confirmed a right-sided colon cancer.
Several endoscopic methods have been described for the retrieval of tissue from submucosal
gastric tumors, including the use of jumbo biopsy forceps, the ”biopsy-on-biopsy“
technique, and the combination of strip biopsy and bite biopsy [1]. The use of endoscopic ultrasound-guided fine-needle aspiration is a less accepted
method for the diagnosis of gastric submucosal lesions because its sensitivity for
cytopathological diagnosis is only 60 % [2]
[3]. Although the needle-knife was originally described for facilitating biliary endoscopy,
several reports have documented its usefulness in the management of intestinal luminal
conditions [4]
[5]. This case demonstrates a further endoscopic application of the needle-knife for
such conditions.
Figure 1 Endoscopic view of a large antral submucosal tumor located in the greater curvature
of the stomach, 3 cm from the pylorus. The mucosa covering the mass did not differ
from the surrounding antral mucosa.
Figure 2 The needle-knife was advanced through the working channel of the endoscope until two-thirds
of the total length of the needle-knife was exposed. Pure cutting electrical current
was then applied using the ERBE electrosurgical generator.
Figure 3 An incision, 1.5 cm in length, was made on the center of the mass, involving the mucosa
and part of the submucosa.
Endoscopy_UCTN_Code_TTT_1AO_2AC
