Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2016; 22(23): 5454-5458
Published online Jun 21, 2016. doi: 10.3748/wjg.v22.i23.5454
Endoscopic en bloc resection of an exophytic gastrointestinal stromal tumor with suction excavation technique
Hyuk Soon Choi, Hoon Jai Chun, Kyoung-Oh Kim, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim
Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea
Kyoung-Oh Kim, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon 21565, South Korea
Author contributions: Chun HJ designed the report; Kim ES, Keum B, Jeen YT, Lee HS and Kim CD collected the patient’s clinical data; Choi HS and Kim KO analyzed the data and wrote the paper.
Supported by Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea, No. HI14C3477; and Korea University grant, No. K1523601.
Institutional review board statement: The study was approved by the institutional review board of Korea University Anam Hospital, No. AN15332-001.
Informed consent statement: This patient provided informed consent before participation.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hoon Jai Chun, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Inchon-ro 73, Seongbuk-gu, Seoul 02841, South Korea. drchunhj@chol.com
Telephone: +82-2-9206555 Fax: +82-2-9531943
Received: January 7, 2016
Peer-review started: February 2, 2016
First decision: March 21, 2016
Revised: April 1, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 21, 2016
Processing time: 132 Days and 15.6 Hours
Abstract

Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor (GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further management of a gastric subepithelial tumor on the lesser curvature of the lower body, originally detected via routine upper gastrointestinal endoscopy. Abdominal computed tomography and endoscopic ultrasound showed a 4-cm extraluminally protruding mass originating from the muscularis propria layer. The patient firmly refused surgical resection owing to potential cardiac problems, and informed consent was obtained for endoscopic removal. Careful dissection and suction of the tumor was repeated until successful extraction was achieved without serosal injury. We named this procedure the suction excavation technique. The tumor’s dimensions were 3.5 cm × 2.8 cm × 2.5 cm. The tumor was positive for C-KIT and CD34 by immunohistochemical staining. The mitotic count was 6/50 high-power fields. The patient was followed for 5 years without tumor recurrence. This case demonstrated the use of endoscopic resection of an exophytic GIST using the suction excavation technique as a potential therapy without surgical resection.

Keywords: Gastrointestinal stromal tumor; Endoscopic resection; Submucosal tumor; Subepithelial tumor; En bloc resection

Core tip: Most small gastrointestinal stromal tumor (GISTs) are treated surgically, and endoscopic resection is contraindicated as the risk of perforation and incomplete resection is high. However, several authors recently reported successful results with endoscopic resection of a subepithelial tumor originating from the muscularis propria layer, including GISTs. A GIST with exophytic growth was previously considered a contraindication for endoscopic resection. In cases of exophytic GISTs, surgical or endoscopic full-thickness resection with laparoscopic support is generally indicated. However, this case shows that even exophytic GISTs can potentially be endoscopically resected without perforation using the suction excavation method.