Endoscopic Resection of a Large Submucosal Tumor Causing Intermittent Gastric Outlet Obstruction Using a Novel Radiofrequency Enabled Device

Abstract

Gastric lipomas are rare benign tumors and account for 1-3% of all benign gastric tumors. Majority of the gastric lipomas are asymptomatic and do not demand resection. However, large gastric lipomas may present with upper gastrointestinal bleeding and more rarely gastric outlet obstruction. Traditionally, surgery has been utilized for the management of giant gastric lipomas. More recently, endoscopic techniques are increasingly utilized for the resection of gastric submucosal lesions. Here we describe a case with large gastric lipoma who presented with symptoms suggestive of gastric outlet obstruction. Gastroscopy revealed a large (6 cm) submucosal lesion with a broad peduncle located in antrum. The tumor was prolapsing into duodenum thereby, completing occluding the pylorus. In this case, we performed endoscopic submucosal dissection using a novel, bipolar radiofrequency device. The dissection was completed without any complication.

New Kid on the Block: “Speedboat”

“…We have described the use of this device in our previous study and several video case reports. 4 5 6 7 In brief, the standard steps of ESD and tunneling endoscopic procedures remain the same ( Figs. 3 4 5 6 ).…”

“…8 11 12 More recently, submucosal tunneling procedures including POEM and STER have been successfully performed using Speedboat device. 4 5 6 7 13…”

“…14 Subsequent to this study, several case reports have been published demonstrating the feasibility and safety of performing ESD in colorectum and stomach using Speedboat device. 7 11 12 More recently, Speedboat device has been utilized for performing third space endoscopy procedures. Nabi et al reported the utility of this device for performing submucosal tunneling procedures including POEM and STER ( Figs.…”