ABSTRACT
Gastrointestinal stromal tumors are common gastrointestinal tumors typically originating from the muscularis propria layer of the stomach. Small gastric stromal tumors are usually detected incidentally during routine endoscopic examination. Although they may have malignant potentially, controversies remain regarding the need for endoscopic resection of small gastric stromal tumors originating from the muscularis propria. According to the guidelines of the European Society of Medical Oncology, all gastrointestinal stromal tumors >2 cm in size should be resected with endoscopic surveillance recommended for tumors <2 cm. Endoscopic resection including endoscopic mucosal dissection (EMD), endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection and snare assisted endoscopic resection. However, EMD and ESD procedures may be accompanied with serious complications including perforation, bleeding, and abdominal infection. Snare-assisted endoscopic resection is an alternative approach and has the advantages of a shorter procedure time and a low rate of perforation or bleeding. This study summarizes the safety and feasibility of a novel snare-assisted endoscopic resection technique and highlights the pros and cons of the different endoscopic approaches currently used for subepithelia small gastric tumors.
ABSTRACT
Full thickness endoscopic resection of large submucosal gastric tumors (>3 cm) is a big challenge for endoscopists. Issues include how to efficiently resect the lesion, obtain homeostasis, and suture the defect. There are no guidelines regarding the importance of patient position on the success of endoscopic resections in anesthetized patients. Typically, the patient is placed in left lateral position for the endoscopic therapy and during the procedure patient's position is changed to maintain the tumor above the gastric fluids to prevent gastric juices and tumor or tumor fragments from falling into the peritoneal cavity in the event of perforation. This study emphasized the importance of planning the procedure to ensure that the patient's position and anesthetist's concerns are met and allow optimal access to the lesion for endoscopic resection. Prior to sedation the patient should be positioned so that the tumor is in the up position which also prevents blood obscuring the operative field, helps detect bleeding points for immediately hemostasis. In addition, due to gravitational effect, the resected tumor will fall into the gastric cavity exposing the root of the tumor making resection easier and reduce procedure time. Preplanning avoids unnecessary readjustment of positioning and improves the ease and safety of the procedure.
