Loop-and-let-go technique for a bleeding, large sessile gastric gastrointestinal stromal tumor (GIST)

Abstract

A 77-year-old woman was admitted for syncope followed by melena. She was under oral anticoagulant therapy for atrial fibrillation. An urgent upper endoscopy revealed active oozing of blood from an ulcer crater on the surface of a 3.5-cm, sessile submucosal tumor at the gastric fundus. Endoscopic hemostasis was achieved by epinephrine injection and application of hemoclips ([Fig. 1]). Although surgical gastric wedge resection is considered the gold standard treatment for such lesions ≥ 2 cm in size, since the patient presented a high risk for general anaesthesia and recurrent bleeding as well as the need of further anticoagulant therapy, we were forced to consider endoscopic treatment. Endoscopic snare resection and submucosal dissection are associated with a significant risk of perforation [1]. Endoscopic band ligation technique has been described as effective for smaller lesions [2]. Another alternative, the endoloop technique, has also been recently reported as potentially effective, provided the loop is tightened around the base of the lesion, which results in tissue strangulation and slow mechanical transection of a gastrointestinal stromal tumor (GIST), that is, ischemic necrosis followed by spontaneous sloughing [3].