P208 Endoscopic full thickness resection of gastric subepithelial lesions: the largest UK case series

Introduction

Subepithelial lesions (SELs) of the upper gastrointestinal tract are detected in 1 in every 300 patients undergoing gastroscopy. The natural history of small (<2cm) gastric SELs is unknown. As a result, they typically undergo long term endosonographic surveillance. Endoscopic full thickness resection (EFTR) is emerging as a desirable option for these lesions enabling us to offer a histological diagnosis to this cohort of patients. Here we report our experience of EFTR using the full-thickness resection device (Ovesco Endoscopy Tubigen, Germany) for small gastric SELs. This represents the largest cases series in a UK cohort of patients.

Methods

We retrospectively evaluated all cases where EFTR was conducted on small gastric SELs at our tertiary upper GI centre. All cases were performed under general anaesthetic. We adopted a hybrid approach by performing a circumferential incision of the lesion with an ESD knife prior to resection with the EFTR device. Balloon dilatation was performed of the cricopharynx in all patients to enable passage of the EFTR device. Outcomes measures included technical success, histological diagnosis and clinical success which was defined by the R0 resection rate and the full thickness resection rate.

Results

EFTR was conducted on 12 patients (7 female). The mean patient age at the time of the procedure was 57 (IQR 45–68). The mean size of the lesion was 14mm (+/- 4.5). Full thickness resection was not achieved in any cases. R0 resection was achieved in 75% (9/12) of cases. All cases had submucosa sampled. Chart 1 highlights the histological diagnosis for all 12 patients. Chart 1: Histological diagnosis following EFTR The technical success rate was 92% (11/12) with no reports of bleeding or perforation across the whole case series. The single case of technical failure occurred due to failure of the clip deployment from the EFTR device. This did not result in acute perforation and a single suture was applied to partially close the defect.

Conclusion

EFTR is safe and technically feasible for small gastric SELs. Further work is needed to achieve full-thickness resection. This was not achieved by our centre even when performing a hybrid approach with circumferential incision of lesions. Nonetheless we were able to provide a diagnosis in 92% (11/12) of cases and liberate these patients from ongoing endosonographic surveillance.