University of Texas Health Science Center at Houston Houston, TX, United States
Layth Alzubaidy, MD1, Kevin K. Yu, MD, MS1, Tejal Mistry, MD1, Nirav Thosani, MD, MHA2 1University of Texas Health Science Center at Houston, Houston, TX; 2University of Texas Health Science Center, Houston, TX
Introduction: Conventional endoscopic procedures to resect gastrointestinal neoplasms are limited to the superficial layers of the GI wall. Endoscopic Full-Thickness Resection (EFTR) has received attention as a minimally invasive procedure because enables endoscopist to resect lesions involving the muscularis layer. Here, we present a case of EFTR for gastric leiomyoma found incidentally at challenging location, the GE Junction, and resected successfully under a retroflexed view.
Case Description/Methods: . A 64-year-old female with history of hypothyroidism, sleep apnea, gastroesophageal reflux disease (GERD), and hiatal hernia of less than 2 cm who presented to gastroenterology clinic for further evaluation and work-up for long-standing GERD refractory to proton pump inhibitor therapy. Initial EGD screen showed a 16 x 11 mm mass at GEJ. The lesion appeared to have arisen from the submucosa with no involvement of the muscularis propria on EUS. Biopsy established a diagnosis of gastric leiomyoma. Due to continued GERD symptoms, the patient subsequently underwent a repeat EGD with EFTR with surgery backup for resection of the mass (Video 1). A careful examination of the site of resection was conducted and subsequently closed with 10 clips. Patient was admitted for overnight observation and discharged the next day. Negative margins confirmed with pathology. After three months, the patient reported no residual symptoms of acid reflux. There were no procedural complications.
Discussion: We present successful case of a technically challenging retroflexed EFTR of a gastric leiomyoma at the GEJ. Due risk of complications, lesions in the GEJ historically are very difficult to resect using conventional endoscopic and surgical techniques. With the development of reliable endoscopic closure techniques and tools, EFTR is emerging as a therapeutic option for the treatment of such challenging lesions [3, 4]. Traditionally, a partial gastrectomy is performed to resect masses found at the GEJ, which carries a significant risk of morbidity and mortality . However, a skilled and experienced performed under retroflexed view and require the endoscopist to carefully consider of the changes to endoscope movement and the countertraction required to facilitate dissection . This case demonstrates that EFTR is a safe and well-tolerated procedure which can utilized by skilled endoscopists to resect masses in challenging locations, thereby reducing morbidity and financial burdens on both patients and health systems.
Disclosures: Layth Alzubaidy indicated no relevant financial relationships. Kevin Yu indicated no relevant financial relationships. Tejal Mistry indicated no relevant financial relationships. Nirav Thosani indicated no relevant financial relationships.
Layth Alzubaidy, MD1, Kevin K. Yu, MD, MS1, Tejal Mistry, MD1, Nirav Thosani, MD, MHA2. P2795 - Endoscopic Full-Thickness Resection (EFTR) of Gastric Leiomyoma (With Video), ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.