The Red Section

Am J Gastroenterol 2017; 112:679; doi:10.1038/ajg.2016.590

Endoscopic Submucosal Resection: A Novel Technique for Resection of a Small Gastric Stromal Tumor from the Muscularis Propria

Lianyong Li1, Sarah Cristofaro2, Xiaojiang Zhou3, Lin Xu4, Changmin Qu1, Shuwen Liang1 and Qiang Cai2

  1. 1Department of Gastroenterology, PLA 306th Hospital, Beijing, China.
  2. 2Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.
  3. 3Department of Gastroenterology, the First Affiliated Hospital, Nanchang University, Nanchang, China.
  4. 4Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, China.

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An endoscopic mucosa resection (EMR) kit is usually used for resection of small superficial lesions in the upper gastrointestinal tract. For lesions such as a gastric stromal tumor (GST) arising from deeper layers, surgery or endoscopic full-thickness resection is required. The accompanying video demonstrates a new technique, endoscopic submucosal resection (ESMR) using an EMR kit for resection of a small GST arising from the muscularis propria (MP). A 1.5-cm submucosal mass arising from the MP near the gastroesophageal juncion was identified in a 70-year-old woman (figure and video). After the mass was raised by an injection of methylene blue diluted with saline, a 2-cm incision was made into the mucosa overlying it using an Erbe HybridKnife (Erbe USA, Incorporated, Marietta, GA). The lesion was identified, and the HybridKnife was used to perform limited dissection around the mass, which was then attracted by the attached cap. Next, a Captivator EMR kit (Boston Scientific, Marlborough, MA) was assembled and a band was applied at the base of the mass. After snare cautery resection below the band, three hemoclips were placed. The MP remained intact, and there were no adverse events. Pathology confirmed a gastrointestinal stromal tumor with an intact capsule. This new ESMR technique required only about 15 minutes. (Informed consent was obtained from the patient to publish these images.)

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