Department of Gastroenterology Performs First Ultra-Minimally Invasive Procedure — Endoscopic Full-Thickness Resection of Transmural Gastric Stromal Tumor
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News
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2025-01-13
Recently, a 60-year-old patient presented to the Department of Gastroenterology at HeYou Hospital with abdominal pain. Endoscopic ultrasound revealed a mass measuring approximately 2.0×1.6 cm in the muscularis propria of the gastric fundus, with localized calcification. Combined with an upper abdominal CT scan, the findings indicated a relatively dangerous gastric stromal tumor requiring resection.
In the past, treatment for larger gastric stromal tumors often relied on surgical intervention. Professor Li Ziyu, Director of the Department of Gastroenterology, believed that although the lesion was located in the gastric fundus fornix, growing both intraluminally and extraluminally, making the surgical site particularly challenging, complete endoscopic resection was still possible. Ultimately, the procedure was performed by Associate Chief Physician Zhao Jiwei, who successfully completed an endoscopic full-thickness resection (EFTR), achieving complete tumor enucleation. Pathology confirmed a gastrointestinal stromal tumor (spindle cell type).
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EFTR is one of the most technically demanding level-4 endoscopic procedures. Performing this surgery requires overcoming six major challenges:
① The tumor is located near the gastric fundus fornix, with an unfavorable position and angle for manipulation.
② The gastric fundus has a rich blood supply, posing a significant risk of bleeding.
③ The lesion is relatively large, and the traction force of the instruments used during dissection is relatively weak, making manipulation difficult.
④ The lesion grows both intraluminally and extraluminally. After incising the gastric mucosal surface, the inward traction of the mucosa on the lesion is weakened, causing the lesion to be pulled outward into the abdominal cavity, complicating dissection.
⑤ After tumor resection, gas from the stomach enters the abdominal cavity, requiring the procedure to be completed quickly to avoid compromising respiratory function and other risks.
⑥ The resection wound is large, making wound closure challenging.
In the past, treatment for larger gastric stromal tumors often relied on surgical intervention. Professor Li Ziyu, Director of the Department of Gastroenterology, believed that although the lesion was located in the gastric fundus fornix, growing both intraluminally and extraluminally, making the surgical site particularly challenging, complete endoscopic resection was still possible. Ultimately, the procedure was performed by Associate Chief Physician Zhao Jiwei, who successfully completed an endoscopic full-thickness resection (EFTR), achieving complete tumor enucleation. Pathology confirmed a gastrointestinal stromal tumor (spindle cell type).
---------------------------
EFTR is one of the most technically demanding level-4 endoscopic procedures. Performing this surgery requires overcoming six major challenges:
① The tumor is located near the gastric fundus fornix, with an unfavorable position and angle for manipulation.
② The gastric fundus has a rich blood supply, posing a significant risk of bleeding.
③ The lesion is relatively large, and the traction force of the instruments used during dissection is relatively weak, making manipulation difficult.
④ The lesion grows both intraluminally and extraluminally. After incising the gastric mucosal surface, the inward traction of the mucosa on the lesion is weakened, causing the lesion to be pulled outward into the abdominal cavity, complicating dissection.
⑤ After tumor resection, gas from the stomach enters the abdominal cavity, requiring the procedure to be completed quickly to avoid compromising respiratory function and other risks.
⑥ The resection wound is large, making wound closure challenging.
