Tips on pre-emptive hemostasis of large vessels during endoscopic full-thickness resection of a large gastrointestinal stromal tumor

Q3 Medicine

VideoGIE Pub Date : 2025-03-22 DOI:10.1016/j.vgie.2025.03.030

Abdullah Abbasi MD , Maham Hayat MD , Saurabh Chandan MD , Sagar Pathak MD , Muhammad K. Hasan MD , Kambiz K. Kadkhodayan MD , Peter V. Draganov MD , Dennis Yang MD

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引用次数: 0

Abstract

Background and Aims

Exposed endoscopic full-thickness resection is often necessary for the management of large subepithelial lesions or those extending deep into the GI wall. Despite advances in endoscopy, our toolbox for the prevention and management of bleeding from large vessels remains limited. This video case report demonstrates the successful removal of a large gastrointestinal stromal tumor in the fundus, with a focus on our endoscopic approach to the management of large peritoneal vessels.

Methods

An exposed endoscopic full-thickness resection procedure was performed using a needle-type and insulated tip electrocautery knife. Endoscopic ligation of blood vessels was performed using through-the-scope clips, whereas closure of the gastric wall defect was accomplished with over-the-scope suturing.

Results

An 82-year-man with multiple comorbidities was found to have gastric fundal gastrointestinal stromal tumor on computed tomography and confirmed on endoscopic ultrasound fine-needle aspiration. After multidisciplinary discussion, he was planned for endoscopic resection. Given the size of the lesion and exophytic component, exposed endoscopic full-thickness resection was performed. Large peritoneal feeding vessels were identified. For pre-emptive hemostasis, through-the-scope clips were used for ligation before vessel transection. This approach was effective and resulted in sufficient mechanical tamponade to permit adequate visualization for targeted intervention when bleeding ensued. The remainder of the lesion was subsequently dissected without any issues. Closure of the large full-thickness defect was achieved using the over-the-scope suturing system.

Conclusions

We present pre-emptive endoscopic hemostatic strategies when encountering large vessels. Innovation and development of dedicated devices are urgently needed to increase the efficiency and safety of these procedures as we continue to expand our therapeutic boundaries.

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内镜下大胃肠道间质瘤全层切除术中大血管先行止血的技巧

背景和目的在处理大的上皮下病变或深入胃肠道壁的病变时，内镜下全层切除术通常是必要的。尽管在内窥镜检查方面取得了进步，但我们用于预防和管理大血管出血的工具箱仍然有限。本视频病例报告展示了眼底大胃肠道间质瘤的成功切除，重点是内镜下大腹膜血管的处理。方法采用针状绝缘尖头电刀行内镜下全层外露切除。内镜下血管结扎是通过镜内夹进行的，而胃壁缺损的闭合是通过镜外缝合完成的。结果1例82岁男性，合并多种合并症，经ct检查为胃底胃肠道间质瘤，经内镜超声细针穿刺确诊。经多学科讨论，计划行内镜切除。考虑到病变的大小和外生成分，我们进行了暴露的内镜全层切除。发现大腹膜供血血管。为了先发制人止血，在血管横断前，使用过镜夹进行结扎。这种方法是有效的，并产生了足够的机械填塞，以便在出血后进行有针对性的干预。病变的其余部分随后被解剖，没有任何问题。使用超范围缝合系统实现了大的全层缺损的闭合。结论在遇到大血管时，我们提出了先发制人的内镜止血策略。随着我们不断扩大治疗范围，迫切需要创新和开发专用设备来提高这些程序的效率和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.