Introduction

^​Gastrointestinal stromal tumors (GISTs) greater than 2 cm are considered for resection.¹ Those with muscularis propria (MP) involvement as seen on endoscopic ultrasound and/or radiology, require full-thickness resection (FTR), surgery, or a combined laparoscopic/endoscopic approach.² Dedicated endoscopic FTR (EFTR) devices are available but limited to lesions less than 2 cm. We present a GIST resected by EFTR and over-the-scope suture (TTSS) defect closure.

Aims & Methods

This video case report shows the full thickness resection of large gastric GIST in the antrum and successful closure of full thickness defect with endoscopic suturing.

Results

A 55yr old gentlemen with history of dyspeptic symptoms suffering from 6 months. There were no history of vomitings, pain abdomen and weight loss. On upper gastrointestinal endoscopy, a sub epithelial lesion of size 3x3 cms size seen in antrum with normal overlying mucosa. On cross sectional imaging with contrast CT, no extramural extension noted. Endoscopic ultrasound of the lesion showed a capsulated heteroechoic lesion arising from muscularis propria 4th layer. After discussing with the patient about the treatment options such as surgery and endoscopic submucosal dissection (ESD). Patient opted for ESD and was taken up for the procedure. It was challenging in the dissection of the lesion in total preserving the muscularis propria but invariably as the lesion involving muscularis propria. The full thickness resection was done and lesion retrieved successfully. As the defect was large and full thickness opening up the peritoneum, endoscopic suturing would be ideal for the effective closure. Using Overstitch Endoscopic suturing system (Boston Scientific), taking full thickness sutures, defect was successfully closed. Patient was allowed orally with liquid initially after 24 hrs. patient was successfully discharged after 36hrs of observation in the hospital. Histopathology of the specimen revealed low risk type Gastrointestinal stromal tumour (GIST).

Conclusion

This case report highlights the use of endoscopic full thickness resection of large gastric GIST and achieving the complete closure using full thickness suturing by endoscopic suturing technique using Overstitch system.

References

1. Kaan HL, Ho KY. Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions. Clin Endosc. 2020
2. Kim HH. Endoscopic treatment for gastrointestinal stromal tumor: Advantages and hurdles. World J Gastrointest Endosc. 2015