PICTURE IN DIGESTIVE PATHOLOGY

Treatment of gastric GIST using endoscopic techniques combined with the application of endoloop and intralesional cyanoacrylate in a non-surgical patient

1Gastroenterology and Digestive Endoscopy Unit. Pablo Tobón Uribe Hospital. Medellín, Colombia.

2Gastroenterology and Digestive Endoscopy Unit. Hospital Universitario Río Hortega. Valladolid, Spain

CASE REPORT

We present the case of a 79-year-old patient with multiple cardiovascular morbidities, classified as ASA III (American Society of Anesthesiology). An upper digestive endoscopy was performed due to chronic anemia and a subepithelial lesion was identified in the subcardial region of 30 x 25 mm, without other relevant findings (Fig. 1A). A radial echoendoscopy was performed to characterize the lesion. A hypoechoic nodular lesion of 25 x 28 mm was identified with a central hyperechoic area with well-defined edges, which was dependent on the muscularis mucosae that extended to the submucosa in an area of 5.8 mm. A single incision needle-knife biopsy (SINK) was accomplished. Pathological analysis showed presence of stromal fusiform cells, with a Ki67 of 2%, a low mitotic index. The patient was evaluated by the Department of General Surgery and was considered to be a non-surgical candidate due to his comorbidities. Thus, endoscopic management was programmed via the application of two endoloops (Fig. 1B), followed by an intralesional injection of cyanoacrylate plus 5 ml of liopidol using a 19G needle (Fig. 1C). Endoscopic control was performed after 12 weeks and a scarred area was identified, without local infiltration (Fig. 1D). Clinical and endoscopic follow-up has not identified evidence of residual lesions after three years of endoscopic intervention.

Fig. 1 A. Endoscopic vision of a subcardial gastric sub-epithelial lesion. B. Endoscopic management via the application of two endoloops. C. Intralesional EUS-guided application of cyanoacrylate. D. Endoscopic control 12 weeks after therapy. C. Intralesional EUS-guided application of cyanoacrylate. D. Endoscopic control 12 weeks after therapy.