Endoscopic resection of rectal gastrointestinal stromal tumor (GIST) using band ligation

Abstract

A 52 year-old male patient was referred for endoscopic resection of a 10 x 6-mm hypoechoic lesion on the anterior wall of the distal rectum. It derived from the “muscularis propria”, and was deemed to be a gastrointestinal stromal tumor (GIST) from its characteristic appearance and localization as shown during endoscopic ultrasonography (EUS) (Fig. 1). An extension study proved negative. Band ligation was chosen for resection. Firstly, the tissue over the lesion was vacuumed with one band, and then a cut was performed under the band using a detachable snare. Thus, the lesion was thoroughly exposed. Afterwards, the lesion was vacuumed and a second band was placed. A new cut below the band was performed (Fig. 2), which dissected the lesion producing a perforation on the rectal wall that was sutured with Resolution clips (Boston Scientific, Natick, Mass). No further complications took place. The patient needed neither hospitalization nor prescribed antibiotics. Pathology confirmed the suspected tumor type. After six months an axial computerized tomogram (CT scan) and a EUS procedure showed no evidence of lesion relapse (Fig. 3).