365 Success of Two Different Endoscopic Submucosal Resection Methods in Gastric Subepithelial Lesions

Abstract

Success of Two Different Endoscopic Submucosal Resection Methods in Gastric Subepithelial Lesions Cetin Karaca*, Ozlem Mutluay Soyer, Filiz Akyuz, Bulent Baran, Asli Ormeci, Suut Gokturk, Kadir Demir, Sadakat Ozdil, Fatih Besisik, Sabahattin Kaymakoglu Istanbul University, Istanbul School of Medicine, Istanbul, Turkey Aim: Gastric subepitelial lesions (GSL) are incidentally detecting during gastroscopy. Endoscopic ultrasound’s (EUS) success is limited in accurate diagnosis. Endoscopic submucosal resection (ESMR) is needed for accurate diagnosis of GSL’s. In this study, we evaluated the usefulness of ESMR with a esophageal band ligation device and saline solution-assisted and snare technique in GSL. Materials and Methods: We analysed gastroscopically detected and ESMR applied GSL cases, retrospectively. GSL’s characterising executed using EUS before ESMR. ESMR executed using saline solution-assisted and snare technique in %50 of cases and using band ligation in rest of cases. Results: A total of 16 patients (10 women, mean age 52.4 years) with an endoscopically resected GSL were included. In EUS examination lesions found %62.5 submucosal, %12.5 mucosal, %25 muscularis propria oriented. The mean size of the 16 lesions was 11mm (range 5-20mm). An endoscopic cap band mucosectomy device was used to resect 8 (50%) lesions, whereas 8 (50%) were resected with a saline solutionassisted and snare technique. ESMR was successfully performed in all 16 GSLs. The en bloc resection rate was 100% (16/16). Lesions pathological diagnosis are found as; ectopic pancreas 3 (%18.7), inflammatory fibroid polyp 3 (%18.7), leiyomyoma 2 (%12.5), lipoma 2 (%12.5), neuroendocrine tumour 1 (%6.3), foveolar epihtelium hyperplasia 3 (%18.7), lymphangiectasia 1 (%6.3), maltoma 1 (%6.3). There were no complications developed during EMR applications using saline solution-assisted and snare technique however endoscopy required bleeding developed in 1 patient during EMR applications using esophageal band ligation. Questioning patient revealed aspirin usage. Conclusions: EMR using adrenaline or band ligation is effective technique with low complication ratio in diagnosis and treatmentof GSL’s smaller than 2cm diameter.