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DOI: 10.1055/s-0029-1214929
© Georg Thieme Verlag KG Stuttgart · New York
A new device for endoscopic submucosal dissection of a submucosal gastrointestinal stromal tumor
PD Dr. J. MaissMD
Gastroenterology Clinic Dr. Kerzel/PD Dr. Maiss
Mozartstr. 1
D-91301 Forchheim
Germany
Fax: +49-9133-602618
Email: juergen.maiss@uk-erlangen.de;
Email: j.maiss@t-online.de
Publication History
Publication Date:
15 September 2009 (online)
Surgical resection is the treatment of the choice for gastrointestinal stromal tumors (GIST). These neoplasms usually arise from the muscularis propria. Endoscopic submucosal dissection (ESD) is a novel technique to resect epithelial as well as submucosal gastrointestinal neoplasia and represents a less invasive alternative to surgery [1] [2] [3]. Recently, many technical developments and accessories have been presented to facilitate the ESD procedure [3] [4] [5]. The following case report presents the successful ESD of a submucosal gastric GIST using a new combined instrument, the Endo-FS/FK dissection device (KACHU Technology, Seoul, Korea), which integrates an injection needle and a flex knife into a single device.
A submucosal tumor, 15 – 20 mm in size, was incidentally found in the stomach of a 72-year-old man. The lesion was located at the posterior wall in the proximal part of the gastric antrum ([Fig. 1]). Endoscopic ultrasound revealed a 15 mm homogeneous tumor, presumably of a benign or premalignant nature (lipoma, leiomyoma, or GIST) ([Fig. 2]). As the patient refused surgery, ESD was carried out using the new combination dissection device, the Endo-FS/FK ([Fig. 3]; [Video 1]). The whole procedure (marking, injection, dissection) was carried out using only this instrument. After marking with the flexible snare tip, a high-volume submucosal injection was given, using the integrated injection needle of the Endo-FS/FK device. A dilute epinephrine solution with indigo carmine dye (1 mg epinephrine and 1 mL 0.8 % indigo carmine in 250 mL 0.9 % saline solution) was used to broaden the submucosal layer. A circumferential incision was made with the flexible snare tip of the Endo-FS/FK device. Subsequently, the dissection with the flexible snare tip was interrupted by injections of the dilute epinephrine and indigo carmine solution, again using the integrated injection needle. Thus, time-consuming changing of accessories was avoided and the whole tumor was dissected with the flexible snare tip of the Endo-FS/FK device. Finally, hemostasis of oozing bleeding was achieved with a Coagrasper device (Olympus Endotherapy, Hamburg, Germany). Histological examination of the resection specimens revealed a 15 mm GIST with a proliferation rate of 2 – 3 % (MIB1). In addition, the tumor expressed CD117 and CD34 markers, and so the patient’s situation was determined to be low risk. A control gastroscopy 1 day later revealed an arterial stump in the center of the resection ulcer. Three endoclips (HX-610-090, Olympus Endotherapy, Hamburg, Germany) were applied for hemostasis ([Fig. 4]). The patient recovered rapidly and was discharged 48 hours after resection. Follow-up 1 and 3 months after resection showed regular healing without any signs of recurrence.
Endoscopy_UCTN_Code_TTT_1AO_2AG
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References
- 1 Kakushima N, Fujishiro M, Kodashima S. et al . A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy. 2006; 38 991-995
- 2 Lee I L, Lin P Y, Tung S Y. et al . Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy. 2006; 38 1024-1028
- 3 Rosch T. Endoscopic submucosal dissection (ESD): an overview of articles in this issue. Endoscopy. 2006; 38 978-979
- 4 Kume K, Yamasaki M, Kanda K. et al . Endoscopic submucosal dissection using a novel irrigation wiper-knife. Endoscopy. 2007; 39 Suppl 1 E144
- 5 Neuhaus H, Costamagna G, Deviere J. et al . Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy. 2006; 38 1016-1023
PD Dr. J. MaissMD
Gastroenterology Clinic Dr. Kerzel/PD Dr. Maiss
Mozartstr. 1
D-91301 Forchheim
Germany
Fax: +49-9133-602618
Email: juergen.maiss@uk-erlangen.de;
Email: j.maiss@t-online.de
References
- 1 Kakushima N, Fujishiro M, Kodashima S. et al . A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy. 2006; 38 991-995
- 2 Lee I L, Lin P Y, Tung S Y. et al . Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy. 2006; 38 1024-1028
- 3 Rosch T. Endoscopic submucosal dissection (ESD): an overview of articles in this issue. Endoscopy. 2006; 38 978-979
- 4 Kume K, Yamasaki M, Kanda K. et al . Endoscopic submucosal dissection using a novel irrigation wiper-knife. Endoscopy. 2007; 39 Suppl 1 E144
- 5 Neuhaus H, Costamagna G, Deviere J. et al . Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy. 2006; 38 1016-1023
PD Dr. J. MaissMD
Gastroenterology Clinic Dr. Kerzel/PD Dr. Maiss
Mozartstr. 1
D-91301 Forchheim
Germany
Fax: +49-9133-602618
Email: juergen.maiss@uk-erlangen.de;
Email: j.maiss@t-online.de