Over-the-scope pre-looping method using an endoloop in endoscopic full-thickness resection of gastric gastrointestinal stromal tumor

Endoscopic full-thickness resection (EFTR) for small gastric gastrointestinal stromal tumors (GISTs) is a feasible and effective procedure [1]. However, visual field obstruction during defect approximation post-EFTR often poses a challenge due to inadequate gastric distension [2].

To address this, we developed a method where an endoloop is maneuvered over the scope to the circumferential incision, forming a “pre-loop” that allows for rapid approximation of the full-thickness defect after EFTR. A 72-year-old man presented with a submucosal tumor measuring 25 mm in diameter, suspected to be a GIST located on the anterior wall of the middle gastric body ([Fig. 1]). The EFTR was performed in an operating room setting ([Video 1]). To minimize the size of the full-thickness defect, submucosal dissection was initially performed around the lesion ([Fig. 2]). After identifying the lesion’s capsule, an endoloop was advanced while grasping the scope tip and positioned over the scope ([Fig. 3]). The loop was then opened at the mucosal incision site and anchored with endoclips, a technique we term “pre-looping” ([Fig. 4]).

Fig. 1 A 25-mm submucosal tumor located on the anterior wall of the middle part of the gastric body.

Fig. 2 Submucosal dissection was performed to reduce the full-thickness defect area.

Fig. 3 An endoloop was used to grasp the tip of the scope and placed over the scope.

Fig. 4 The endoloop was anchored using endoclips, a technique we term the “pre-looping” method.

Endoscopic full-thickness resection (EFTR) was performed in the operating room for a gastric gastrointestinal stromal tumor (GIST) in a 72-year-old man. An over-the-scope pre-looping suture method using an endoloop was performed after EFTR.Video 1

The procedure took 10 min, with endoloop approximation completed post-EFTR. Approximation of the full-thickness defect required an additional 3 min, followed by closure of a residual mucosal defect using a second endoloop ([Fig. 5]). The total approximation time was 21 min.

Fig. 5 Complete approximation of the defect area following tumor excision.

The patient experienced no intraoperative or postoperative complications and was discharged on the fifth postoperative day. Pathological analysis confirmed a low-risk GIST with negative horizontal and vertical margins.

This suture technique remains effective even in cases where gastric lumen collapse follows EFTR, making it a quick and reliable method for defect closure. We intend to adopt this technique as a standard for EFTR in our hospital.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Shichijo S, Abe N, Takeuchi H. et al. Endoscopic resection for gastric submucosal tumors: Japanese multicenter retrospective study. Dig Endosc 2023; 35: 206-215
• 2 Yamamoto Y, Uedo N, Abe N. et al. Current status and feasibility of endoscopic full-thickness resection in Japan: results of a questionnaire survey. Dig Endosc 2018; 30: 2-6

Publikationsverlauf

Artikel online veröffentlicht:
26. November 2024