ID: 3527921 ENDOSCOPIC INTRAPERITONEAL SUBSEROSAL DISSECTION (EISD): BETTER VIEW, SAFER OPERATION

Abstract

Gastric submucosal tumor (SMT) originated from deep layers of the gastric wall can be resected by EFTR or STER. However, the lesions are usually in a tangent position, and the endoscopic view from gastric lumen is inherent poor. In addition, the highly movable tumor with limited endoscopic exposure increases the difficulty in the en bloc resection as well as safe hemostasis. Herein, we developed a modified method, called endoscopic intraperitoneal subserosal dissection (EISD), for the removal of gastric SMT with predominately extraluminal growth pattern. The specific steps of our technique were as follows. First, 1.5-cm gastric mucosal incision was created about 4-cm proximal to the lesion after submucosal injection. Subsequently, a short submucosal tunnel was created, and the gastric muscularis propria was then intentionally perforated about 3-cm away from the lesion. After locating the lesion on the serosa from the abdominal cavity, the tumor was carefully dissected from the serosa and the underlying muscularis propria without interruption of the tumor capsule. Subserosal injection was performed when necessary to create working space or to identify the layer. Caution should be taken to avoid the damage of the integrity of the mucosa during the dissection. The lesion was then removed after full dissection. Finally, after careful hemostasis, the tunnel entrance was closed. The video showed the two EISD cases of stromal tumor in the gastric body originated from the deep muscularis propria with predominantly extraluminal growth. The operating time was 70 and 65 minutes, respectively. The follow-up endoscopy and CT showed satisfactory healing with no residual tumor.