Mucosectomy device‐assisted endoscopic resection of gastric subepithelial lesions

AIM: Some gastrointestinal subepithelial tumors (SETs) have malignant potential and complete resection may be required. However, endoscopic submucosal dissection (ESD) can be tedious procedures and require a long and extensive training to master. Devices for endoscopic full-thickness resection (EFTR) are limited and not widely available. We report here a simpler endoscopic method to resect small SETs using a commercially available endoscopic mucosal resection (EMR) kit and enucleation technique. METHODS: All patients with SETs who underwent device-assisted resection at our tertiary care hospital during April 2015 and November 2016 were enrolled in this retrospective study. All procedures were performed by a single expert endoscopist with an advanced endoscopy trainee. A mucosotomy and a limited dissection under mucosa were performed to preserve the mucosa before device-assisted nucleation of the tumor to facilitate endoscopic closure of the defect closure in all cases. RESULTS: A total of 12 patients (6 male, age 38 to 70 years old) were included. Most of the tumor were originated from the muscularia propria and located at the proximal gastric body. The mean procedural duration was 53 minutes (ranged 23 to 91 minutes). The average size of the lesions was 13 mm (ranged 9-21 mm). The mean duration of hospitalization was 1.3 days. Bleeding and intentional perforation were all successfully managed during the procedure and did not result in any clinically significant adverse event. CONCLUSIONS: A device-assisted EFTR using a commercially available EMR kit is a safe and feasible method for endoscopic resection of small gastric extrovert SETs.