H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine Orange, CA, United States
Anastasia Chahine, MD1, Samuel Ji, DO2, Peter H. Nguyen, MD2, Sagar Shah, MD3, Jennifer Kolb, MD, MS2, Jason Samarasena, MD4 1H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA; 2University of California Irvine, Orange, CA; 3University of California Los Angeles, Los Angeles, CA; 4University of California - Irvine, Orange, CA
Introduction: Management of gastric subepithelial lesions (SEL) varies according to size and layers involved. Guidelines differ in their recommendations especially for smaller lesions. If endoscopic or surgical resection is chosen the goal is to achieve en-bloc resection with negative margins while minimizing adverse events such as perforation. We are presenting 2 cases in which a novel OTSC gastroduodenal full-thickness resection device (gFTRD) was used for the resection of small gastric SELs.
Case Description/Methods: Case 1: A 79 year-old female presenting with epigastric abdominal pain underwent esophagogastroduodenoscopy (EGD) for evaluation of dyspepsia. On endoscopic ultrasound, an 11 x 11mm hypoechoic and round submucosal lesion was noted in the lesser curvature of the gastric body. The lesion was limited to the stomach without extension into surrounding structures and appeared to arise from the muscularis mucosae. Fine needle aspiration with cytology showed spindle cells positive for KIT (CD117), consistent with a gastrointestinal stromal tumor (GIST). Endoscopic full thickness resection was performed using gFTRD. First, the lesion borders were marked and the scope was equipped with the FTRD system. The grasper was used to pull and lift the lesion into the cap and the clip was deployed followed by snare cautery. The specimen was retrieved en-bloc and the resection site looked appropriate with the clip in place. Biopsy results showed clear margins and there were no procedure-related adverse events. Case 2: A 58 year-old male presented for endoscopic resection of a suspected GIST on prior EGD. A 1cm lesion was seen in the lesser curvature of the proximal gastric body. It was first demarcated with cautery marks and then resected using the gFTRD. There were no immediate or delayed complications associated with the procedure. The specimen was retrieved en-bloc and biopsy results were consistent with a submucosal leiomyoma (Desmin positive, CD117 negative) with negative margins.
Discussion: The new gFTRD system offers a novel treatment alternative for gastric SELs. These 2 cases demonstrate the feasibility and safety of gFTRD. By using this device technical and clinical success was achieved by obtaining en-bloc resections with negative margins and no adverse events. With this device available, endoscopic resection of small gastric SELs is more feasible and may serve as a good alternative to continued surveillance and/or surgical resection.
Figure: a) GIST b) OTSC deployed c) GIST resected
Disclosures: Anastasia Chahine indicated no relevant financial relationships. Samuel Ji indicated no relevant financial relationships. Peter Nguyen indicated no relevant financial relationships. Sagar Shah indicated no relevant financial relationships. Jennifer Kolb indicated no relevant financial relationships. Jason Samarasena: Conmed – Advisory Committee/Board Member, Consultant. Cook Medical – Grant/Research Support. Docbot – Stockholder/Ownership Interest (excluding diversified mutual funds). Olympus – Consultant. Ovesco – Consultant.
Anastasia Chahine, MD1, Samuel Ji, DO2, Peter H. Nguyen, MD2, Sagar Shah, MD3, Jennifer Kolb, MD, MS2, Jason Samarasena, MD4. P1743 - Endoscopic Full-Thickness Resection of Gastric Subepithelial Lesions Using a Novel Over-The-Scope-Clip (OTSC) System, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.