Submucosal tunneling and en bloc endoscopic resection facilitates laparoscopic transgastric removal of a large GI stromal tumor at the esophagogastric junction

Abstract Background Gastrointestinal stromal tumors (GISTs) at the esophagogastric junction are rare and its treatment is complicated and challenging. Endoscopic resection has advantages with less complications compared to open and laparoscopic surgery. Case presentation We report a 33-year-old male patient who was admitted to our department complaining of abdominal fullness for 20 days. A huge submucosal tumor at the esophagogastric junction was found by upper gastrointestinal endoscopy. We successfully resected the lesion through endoscopic submucosal excavation without complications, which was pathologically confirmed to be a GIST. The patient was discharged 5 days after operation and has been doing well, and there was no recurrence 8 months after the operation. Conclusion ESE is possibly an effective and minimally invasive method of giant esophagogastric junction stromal tumor.

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Faculty Opinions recommendation of Adjuvant Imatinib for High-Risk GI Stromal Tumor: Analysis of a Randomized Trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725906529.793535661 ◽

2017 ◽

Author(s):

Florence Duffaud

Keyword(s):

High Risk ◽

Randomized Trial ◽

Stromal Tumor ◽

Adjuvant Imatinib ◽

Gi Stromal Tumor

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Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy ◽

10.1055/a-1442-2395 ◽

2021 ◽

Author(s):

Geoffroy Vanbiervliet ◽

Alan Moss ◽

Marianna Arvanitakis ◽

Urban Arnelo ◽

Torsten Beyna ◽

...

Keyword(s):

Endoscopic Resection ◽

En Bloc Resection ◽

Endoscopic Management ◽

Duodenal Adenoma ◽

En Bloc ◽

Strong Recommendation ◽

Delayed Bleeding ◽

Duodenal Adenomas ◽

Moderate Quality ◽

Quality Evidence

Main recommendations 1 ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2 ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3 ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4 ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5 ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6 ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7 ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8 ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9 ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.

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Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection

Visceral Medicine ◽

10.1159/000515354 ◽

2021 ◽

pp. 1-14

Author(s):

Arthur Hoffman ◽

Raja Atreya ◽

Timo Rath ◽

Markus Ferdinand Neurath

Keyword(s):

Endoscopic Mucosal Resection ◽

Endoscopic Resection ◽

Complication Rates ◽

Full Thickness ◽

National Guidelines ◽

En Bloc ◽

Early Stages ◽

Mucosal Resection ◽

Submucosal Dissection ◽

Gastrointestinal Lesions

Background: Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4–1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. Summary: Endoscopic treatment is now regarded as first-line therapy for benign lesions. Key Message: Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.

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Endoscopic Resections in Inflammatory Bowel Disease: A Multicentre European Outcomes Study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz075 ◽

2019 ◽

Vol 13 (11) ◽

pp. 1394-1400

Author(s):

A Alkandari ◽

S Thayalasekaran ◽

M Bhandari ◽

A Przybysz ◽

M Bugajski ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Endoscopic Resection ◽

Bowel Disease ◽

En Bloc ◽

Increased Risk ◽

Delayed Perforation ◽

Inflammatory Bowel ◽

Outcomes Study ◽

Almost All ◽

Current Guidelines

Abstract Background and Aims Inflammatory bowel disease is associated with an increased risk of colorectal cancer, with estimates ranging 2–18%, depending on the duration of colitis. The management of neoplasia in colitis remains controversial. Current guidelines recommend endoscopic resection if the lesion is clearly visible with distinct margins. Colectomy is recommended if complete endoscopic resection is not guaranteed. We aimed to assess the outcomes of all neoplastic endoscopic resections in inflammatory bowel disease. Methods This was a multicentre retrospective cohort study of 119 lesions of visible dysplasia in 93 patients, resected endoscopically in inflammatory bowel disease. Results A total of 6/65 [9.2%] lesions <20 mm in size were treated by ESD [endoscopic submucosal dissection] compared with 59/65 [90.8%] lesions <20 mm treated by EMR [endoscopic mucosal resection]; 16/51 [31.4%] lesions >20 mm in size were treated by EMR vs 35/51 [68.6%] by ESD. Almost all patients [97%] without fibrosis were treated by EMR, and patients with fibrosis were treated by ESD [87%], p < 0.001. In all, 49/78 [63%] lesions treated by EMR were resected en-bloc and 27/41 [65.9%] of the ESD/KAR [knife-assisted resection] cases were resected en-bloc, compared with 15/41 [36.6%] resected piecemeal. Seven recurrences occurred in the cohort. Seven complications occurred in the cohort; six were managed endoscopically and one patient with a delayed perforation underwent surgery. Conclusions Larger lesions with fibrosis are best treated by ESD, whereas smaller lesions without fibrosis are best managed by EMR. Both EMR and ESD are feasible in the management of endoscopic resections in colitis.

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Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

Journal of Clinical Medicine ◽

10.3390/jcm10112511 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2511

Author(s):

Yoshitsugu Misumi ◽

Kouichi Nonaka

Keyword(s):

Endoscopic Submucosal Dissection ◽

Endoscopic Mucosal Resection ◽

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Educational Methods ◽

Submucosal Dissection ◽

Management Of Complications

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.

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Endoscopic resection of a rectal gastrointestinal stromal tumor using the submucosal tunneling endoscopic resection (STER) technique

Endoscopy ◽

10.1055/a-1508-5241 ◽

2021 ◽

Author(s):

Timothée Wallenhorst ◽

Jérémie Jacques ◽

Astrid Lièvre ◽

Mael Pagenault ◽

Guillaume Bouguen ◽

...

Keyword(s):

Gastrointestinal Stromal Tumor ◽

Endoscopic Resection ◽

Stromal Tumor ◽

Submucosal Tunneling Endoscopic Resection

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