Abbasi Abdullah, Hayat Maham, Chandan Saurabh, Pathak Sagar, Hasan Muhammad K, Kadkhodayan Kambiz K, Draganov Peter V, Yang Dennis
Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.
VideoGIE. 2025 Mar 22;10(7):349-352. doi: 10.1016/j.vgie.2025.03.030. eCollection 2025 Jul.
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.
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.
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.
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.
对于大型上皮下病变或深入胃肠道壁的病变，通常需要进行暴露式内镜全层切除术。尽管内镜技术有所进步，但我们用于预防和处理大血管出血的工具仍然有限。本视频病例报告展示了成功切除胃底大型胃肠道间质瘤的过程，重点介绍了我们在内镜下处理大型腹膜血管的方法。
使用针型绝缘尖端电灼刀进行暴露式内镜全层切除手术。通过内镜夹进行血管结扎，而胃壁缺损则通过内镜下缝合进行闭合。
一名82岁患有多种合并症的男性在计算机断层扫描中发现胃底有胃肠道间质瘤，并经内镜超声细针穿刺确诊。经过多学科讨论，计划对其进行内镜切除。鉴于病变大小和外生性成分，进行了暴露式内镜全层切除。识别出大型腹膜供血血管。为了进行预防性止血，在切断血管前使用内镜夹进行结扎。这种方法有效，在出血发生时能产生足够的机械压迫，以便进行有针对性干预的充分可视化。随后病变的其余部分顺利切除。使用内镜下缝合系统实现了大型全层缺损的闭合。
我们介绍了遇到大血管时的预防性内镜止血策略。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，以提高这些手术的效率和安全性。
