ASGE DDW Videos from Around the World | 2025-ENDOSCOPIC FULL-THICKNESS RESECTION OF A DUODENAL GASTROINTESTINAL TUMOR IN THE SECOND PORTION OF THE DUODENUM

Video Transcription

Gastrointestinal stromal tumors, or GISTs, most commonly arise in the stomach. GISTs in the duodenum represent a rare and often challenging clinical scenario due to  the complex anatomy of the duodenal pancreatic region. Endoscopic submucosal dissection and endoscopic full thickness resection, or ESD-EFTR, has  been shown to be efficacious for removing gastric GISTs. However, current data are limited for duodenal tumors.  Represent a successful ESD-EFTR of an instantly discovered duodenal GIST. A 65-year-old man with no significant past medical history was found to have a submucosal  duodenal lesion in the second part of the duodenum on routine EGD. A CT scan performed at an outside institution showed a 1.4-centimeter exophytic lesion.  A CT-EGD and endoscopic ultrasound demonstrated a 11-by-11-millimeter lesion originating from the muscularis propria. A U.S.-guided fine-needle biopsy showed a low-grade GIST.  The decision was made to proceed with ESD-EFTR.  The case was discussed with surgery, and given pathology and the second portion of duodenal location, the advised attempt at endoscopic resection, the decision was made to proceed  with ESD-EFTR. The GIST was clearly visualized in the duodenum. Saline with methylene blue was injected with partial lift of the lesion's proximal side.  The gist was seen to clearly penetrate the muscularis propria, prompting careful dissection of the lesion until the full thickness resection was complete.  Thorough endoscopic inspection revealed no bleeding or bowel leakage. Post-closure duodenogram was negative for leak, and the patient had an uneventful post-operative course.  Biopsy confirmed complete lesion resection and a low-grade tumor. The patient was doing well at 3-month follow-up.  Compared to the stomach, the duodenum is a more challenging location to perform resection  due to its thinner wall and higher risk of intra- and post-procedural bleeding and perforation.  This case demonstrates that ESD-EFTR can be an effective, safe, and minimally invasive method of treating duodenal jits.  Our case further supports prior literature that suggests endoscopic resection methods may be equally effective as surgical resection.  In addition, we demonstrate that endoscopic suturing is a viable method of closure and can be used effectively in such cases.

Video Summary

A 65-year-old man was found to have a submucosal duodenal GIST during a routine EGD. After imaging and biopsy confirmed it as a low-grade tumor, endoscopic submucosal dissection with full thickness resection (ESD-EFTR) was performed. Despite the procedural challenges of the duodenal location, the GIST was successfully and safely removed without complications. The patient recovered well and was doing fine at a 3-month follow-up. This case supports ESD-EFTR as a viable, minimally invasive alternative to surgical resection for duodenal GISTs, demonstrating the efficacy of endoscopic methods, including suturing, to manage such complex cases.

Keywords

duodenal GIST

endoscopic submucosal dissection

full thickness resection

minimally invasive

endoscopic suturing