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CC BY 4.0 · Endoscopy 2023; 55(S 01): E761-E762
DOI: 10.1055/a-2081-8284
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Traction and resection in treating gastric submucosal tumor growing extraluminally by using two snares like a ropeway

Lei Gu 
1   Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China
,
Yu Wu 
1   Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China
2   Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease (2020CB1004), Changsha, Hunan, China
3   National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
,
Xiaowei Liu
1   Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China
2   Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease (2020CB1004), Changsha, Hunan, China
3   National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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A 53-year-old woman with upper abdominal pain underwent computed tomography, which showed a lump with an extraluminal growth pattern located at the junction of the gastric body and antrum ([Fig. 1]). Endoscopic full-thickness resection (EFTR) is a feasible approach for gastric submucosal tumor growing extraluminally [1].

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Fig. 1 A submucosal tumor growing extraluminally was found at the junction of the gastric body and antrum.

After marking and submucosal injection, we incised the mucosa and submucosa along with the marker using a DualKnife (Olympus, Tokyo, Japan), and exposed part of the tumor. As we dissected along the margin of the tumor, we found that the tumor originated from the muscularis propria and mainly grew outside the stomach wall; thus we excised the muscularis propria layer near the tumor using an insulation-tipped knife. The major part of the tumor was in the abdominal cavity ([Fig. 2 a]). To expose the basal part and distal end of the lesion, and to prevent the tumor from falling into the abdominal cavity, a snare (SD-210U-25; Olympus) was inserted through the forceps channel to grasp the tumor and pull it into the stomach ([Fig. 2 b]). By using a pair of hemostatic forceps to keep the snare tight externally, we cut off the handle of the snare and pulled the endoscope out through the mouth. We then reinserted the endoscope with a second snare (through the forceps channel) into the stomach, with the second snare progressing over the line of the first snare like a ropeway ([Fig. 2 c], [Video 1]). Under the external traction of the first snare, we trapped and resected the junction of the tumor and gastric wall using the second snare. After retrieving the specimen ([Fig. 2 d]) by pulling back the first snare and endoscope, we reinserted the endoscope and sutured the wound using metal clips.

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Fig. 2 Endoscopic images. a The major part of the exposed tumor was located outside the gastric cavity. b The tumor was grasped and pulled into the gastric cavity by the first snare. c The endoscope with second snare was reinserted along the first snare. d The resected specimen was about 4.0 × 2.8 cm in size.

Video 1 Endoscopic full-thickness resection of a gastric schwannoma growing extraluminally by using two snares like a ropeway.

The patient started a liquid diet and was discharged from hospital 2 days after the procedure. Postoperative pathological analysis revealed schwannoma. Ropeway-like application of two snares might simplified the procedure of EFTR for gastric submucosal tumors growing extraluminally ([Video 1]).

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Yu Wu, MD
Department of Gastroenterology, Xiangya Hospital
Central South University
87 Xiangya Road
Changsha
Hunan 410008
China   

Publication History

Article published online:
26 May 2023

© 2023. 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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Zoom
Fig. 1 A submucosal tumor growing extraluminally was found at the junction of the gastric body and antrum.
Zoom
Fig. 2 Endoscopic images. a The major part of the exposed tumor was located outside the gastric cavity. b The tumor was grasped and pulled into the gastric cavity by the first snare. c The endoscope with second snare was reinserted along the first snare. d The resected specimen was about 4.0 × 2.8 cm in size.