Ligation-assisted endoscopic full-thickness resection combined with presuture for resection of a colonic gastrointestinal stromal tumor

Ligation-assisted endoscopic full-thickness resection (L-EFTR) is commonly used to remove tumors of the gastric muscularis propria [1] [2] but rarely to remove tumors of the colonic muscularis propria because of the limited visual field after colon perforation and the high incidence of peritonitis. Here, we report a novel method, named “ligation-assisted endoscopic full-thickness resection combined with presuture” (L-EFTR-P) ([Video 1]), for the endoscopic full-thickness resection of a gastrointestinal stromal tumor (GIST) in the transverse colon. With the use of L-EFTR-P, closure of the colonic perforation was quick and easy.

Ligation-assisted endoscopic full-thickness resection combined with presuture resection for a gastrointestinal stromal tumor in the transverse colon of a 61-year-old woman.Video 1

A 61-year-old woman underwent a screening colonoscopy, during which a 6-mm submucosal tumor was discovered in the transverse colon ([Fig. 1] a). Endoscopic ultrasound examination revealed that the tumor originated from the muscularis propria ([Fig. 1] b).

Fig. 1 Ligation-assisted endoscopic full-thickness resection combined with presuture (L-EFTR-P) for a gastrointestinal stromal tumor in the transverse colon. a A 6-mm submucosal tumor was detected in the transverse colon. b Endoscopic ultrasound examination revealed that the tumor originated from the muscularis propria. c The ligation device was attached to the front end of the endoscope, and the tumor was surrounded completely by the cap. d The tissue clip was clamped close to the rubber band. e The snare was tightened under the rubber band. f A linear perforation was observed. g The perforation was sutured with tissue clips. h The excised specimen was removed, and the size was measured.

The L-EFTR-P procedure was performed as follows. The ligation device (M00542251; Boston Scientific, Marlborough, Massachusetts, USA) was attached to the front end of the endoscope, and the tumor was surrounded completely by the cap ([Fig. 1] c). After continuous suction, the entire tumor was positioned within the cap, the rubber band was subsequently released for ligation, and the tissue clips (POCC-D-26-195; Micro-Tech (Nanjing), Nanjing, China) were clamped close to the rubber band ([Fig. 1] d). A snare (M00561231; Boston Scientific) was tightened under the rubber band ([Fig. 1] e). The tumor was removed, and a linear perforation was observed ([Fig. 1] f). The perforation was sutured with tissue clips ([Fig. 1] g). The excised specimen was removed, and the size was measured ([Fig. 1] h). The patient had no postoperative complications, including abdominal pain, chills, fever, or intra-abdominal bleeding. Postoperative pathology confirmed that the tumor was a GIST.

The L-EFTR-P technique can effectively partially suture the perforation before tumor resection and thus avoid the occurrence of large perforations, representing a safe, effective, and feasible endoscopic method for tumor resection in the colonic muscularis propria.

Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AF

 

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Guo J, Liu Z, Sun S. et al. Ligation-assisted endoscopic enucleation for the diagnosis and resection of small gastrointestinal tumors originating from the muscularis propria: a preliminary study. BMC Gastroenterol 2013; 13: 88
• 2 Meng Y, Cao C, Song S. et al. Endoscopic band ligation versus endoscopic submucosal dissection and laparoscopic resection for small gastric stromal tumors. Surg Endosc 2016; 30: 2873-2878

Publikationsverlauf

Artikel online veröffentlicht:
14. Januar 2025