Endoscopic full-thickness resection of a gastric subepithelial tumor by using the submucosal tunnel technique with the patient under conscious sedation (with video)

Abstract

A 47-year-old woman was referred to our hospital for evaluation of a gastric subepithelial tumor. EUS revealed a 16.0 11.2–mm, intraluminal growing, hetergeneous, hypoechoic mass originating from the musularis propria. We planned an EFTR of the lesion for he dual purpose of obtaining a histopathological diagosis and performing definite treatment. The instituional review board approved the human trial, and inormed consent was obtained from the patient. All procedures were performed with the patient uner sedation with midazolam and propofol in the enoscopy unit. Aseptic preparation and prophylaxis with road-spectrum antibiotics were carried out. The proedure was done by using a cap-fitted therapeutic gasroscope (GIF-Q260J, D-201-11804; Olympus, Tokyo, apan), with room-air insufflation after gastric lavage Fig. 1; Video 1, available online at www.giejournal. rg).1 After submucosal injection of a hyaluronic acid ixture, a 20-mm transverse incision was made by using flex knife (KD-630L; Olympus).2 A 40-mm submucosal unnel was created by using the endoscopic submucosal issection (ESD) technique.3 After the endoscope roximal seromuscular layer of the tumor.4 A fullhickness incision around three-fourths of the circumerence of the tumor was made by using an IT-2 knife KD-611L; Olympus).5 Then, the tumor was resected ith a snare, and it was suctioned into the cap.6 The ucosal defect in the tunnel was closed successfully by sing the endoloop-clips technique, by using a twohannel gastroscope (GIF-2TQ260M; Olympus).4 The retrieved specimen was identified as a gastric chwannoma. On the second hospital day, the luminal atency of the stomach was confirmed in an EGD and ater-soluble contrast study, and the patient was disharged the following day.