Endoscopic full-thickness resection of a duodenal gastrointestinal stromal tumor.

BACKGROUND AND AIM: There is limited literature regarding endoscopic removal of gastrointestinal stromal tumors (GISTs) located in the duodenum. We present successful endoscopic submucosal dissection and exposed full-thickness resection (FTR) of an incidentally discovered duodenal GIST in an asymptomatic 65-year-old man.

METHODS

The lesion was 1.4 cm and well-defined, primarily located in the submucosal layer of the posterior D2 duodenal wall and the level of the major papilla around 2 cm distal to the ampulla. Transverse mucosotomy was made followed by submucosal dissection. An IT2 knife with a protected tip was used for the majority of resection to preserve the lesion's capsular layer. Methodical dissection was performed until the lesion was removed en bloc. Endoscopic suturing closed the FTR defect with a single running suture. An exposed aspect of the medial mucosal resection site was reinforced with an additional interrupted suture.

RESULTS

Postclosure contrast duodenogram was negative for leak. The patient was monitored for 36 hours inpatient without adverse events. Final pathology confirmed complete en bloc resection of a low-grade GIST with a preserved capsule.

CONCLUSION

Endoscopic submucosal dissection/exposed FTR can be an effective, minimally invasive method of resecting duodenal GISTs. In addition, endoscopic suturing is a viable method of resection defect closure in the duodenum.