Clin Endosc.  2019 May;52(3):283-287. 10.5946/ce.2018.116.

Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal Tumors

• Inayat F
• Aslam A
• Grunwald M
• Hussain Q
• Hurairah A
• Iqbal S

• KMID: 2449771
• DOI: http://doi.org/10.5946/ce.2018.116

Abstract

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arising from the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasingly detected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advanced technique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a number of methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem is appropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge, this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic option in patients with gastric GISTs.

Keyword

Omentum; Endoscopic full-thickness resection; Gastrointestinal stromal tumors; Therapeutic endoscopy; Endoscopic suturing

MeSH Terms

Endoscopy
Gastrointestinal Stromal Tumors*
Gastrointestinal Tract
Humans
Omentum
Stomach

Figure

• 

  Fig. 1. (A) Esophagogastroduodenoscopy identified an approximately 2-cm round submucosal lesion located in the fundus/proximal body along the greater curvature of the stomach. (B) An iatrogenic full-thickness gastric wall defect was created by the endoscopic full-thickness resection. (C) The defect was successfully closed using omental fat patching. Several hemoclips were deployed to affix the fat plug to the gastric wall. (D) The hemoclips were then joined together by an endoloop. (E) Gross appearance of the resected specimen. A fleshy tan-white mass measuring 22 mm in diameter was resected and sent for pathological examination.

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  Fig. 2. (A) Esophagogastroduodenoscopy showing an approximately 2.5-cm intramural submucosal lesion in the gastric cardia along the greater curvature. (B) Endoscopic ultrasound image showing an 18.5×13 mm endophytic submucosal lesion originating from the muscularis propria. (C) The omental fat plug was pulled into the gastric lumen in an attempt to close the defect. (D) Multiple hemoclips were deployed to hold the fat plug within the gastric wall. (E) Endosutures were applied in a purse-string fashion around the hemoclips. (F) Gross morphology of the resected specimen. A multinodular mass with 28-mm ulcerations was resected and sent for pathological examination.

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  Fig. 3. Flowchart showing the omental patching and purse-string technique for closing endoscopic full-thickness resection-related gastric defects in patients with gastrointestinal stromal tumors (GISTs).

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