Submucosal Tunnel Endoscopic Resection of Gastric Lesion Before Obesity Surgery: a Case Series
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Submucosal Tunnel Endoscopic Resection of Gastric Lesion Before Obesity Surgery: a Case Series Gianfranco Donatelli 1 & Fabrizio Cereatti 1,2 & Jean-Loup Dumont 1 & Nelson Trelles 3 & Panagiotis Lainas 4 & Carmelisa Dammaro 4 & Hadrian Tranchart 4 & Filippo Pacini 5 & Roberto Arienzo 5 & Jean-Marc Chevalier 5 & David Danan 1 & Jean-Marc Catheline 6 & Ibrahim Dagher 4 Received: 25 June 2020 / Revised: 11 August 2020 / Accepted: 11 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Submucosal tumors (SMTs) of the gastrointestinal tract are a rare pathological entity comprising a wide variety of neoplastic and non-neoplastic lesions. Even if most SMTs are benign tumors (e.g., leiomyomas), a smaller portion may have a malignant potential (e.g., gastrointestinal stromal tumor (GIST)). Preoperative diagnosis of SMT in bariatric patients may arise challenging clinical dilemmas. Long-term surveillance may be difficult after bariatric surgery. Moreover, according to SMT location, its presence may interfere with planned surgery. Submucosal tunneling endoscopic resection (STER) has emerged as an effective approach for minimally invasive en bloc excision of SMTs. This is the first case series of STER for SMTs before bariatric surgery. Methods Seven female patients underwent STER for removal of SMTs before bariatric surgery. All lesions were incidentally diagnosed at preoperative endoscopy. STER procedural steps comprised mucosal incision, submucosal tunneling, lesion enucleation, and closure of mucosal defect. Results En bloc removal of SMT was achieved in all cases. Mean procedural time was of 45 min (SD 18.6). No adverse event occurred. Mean size of the lesions was 20.6 mm (SD 5.8). Histological diagnoses were 5 leyomiomas, 1 lipoma, and 1 low grade GIST. Bariatric procedure was performed after a mean period of 4.1 months (SD 1.6) from endoscopic resection. Conclusion STER is a safe and effective treatment for the management of SMT even in bariatric patients awaiting surgery. Preoperative endoscopic resection of SMTs has the advantages of reducing the need for surveillance and removing lesions that could interfere with planned surgery. STER did not altered accomplishment of bariatric procedures. Keywords Submucosal tumors . STER . Endoscopy . Sleeve gastrectomy . Bypass . POEM . Leiomyoma . GIST
Introduction Many bariatric centers routinely perform preoperative upper gastrointestinal (GI) endoscopy to rule out the presence of
lesions that may interfere or delay bariatric procedures. However, its real beneficial role is under review with contrasting recommendations from different scientific societies. The American Society of Gastrointestinal Endoscopy (ASGE) and
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04928-z) contains supplementary material, which is available to authorized users. * Gianfranco Donatelli [email protected] 1
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Unité d’Endoscopie Interventionnelle, Hôpital Privé des P
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