title: Endoscopic en bloc resection of an exophytic gastrointestinal stromal tumor with suction excavation technique.
abstract: Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor (GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further management of a gastric subepithelial tumor on the lesser curvature of the lower body, originally detected via routine upper gastrointestinal endoscopy. Abdominal computed tomography and endoscopic ultrasound showed a 4-cm extraluminally protruding mass originating from the muscularis propria layer. The patient firmly refused surgical resection owing to potential cardiac problems, and informed consent was obtained for endoscopic removal. Careful dissection and suction of the tumor was repeated until successful extraction was achieved without serosal injury. We named this procedure the suction excavation technique. The tumor's dimensions were 3.5 cm × 2.8 cm × 2.5 cm. The tumor was positive for C-KIT and CD34 by immunohistochemical staining. The mitotic count was 6/50 high-power fields. The patient was followed for 5 years without tumor recurrence. This case demonstrated the use of endoscopic resection of an exophytic GIST using the suction excavation technique as a potential therapy without surgical resection.
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Hyuk Soon
authors.initials: HS
authors.lastname: Choi
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Kyoung-Oh
authors.initials: KO
authors.lastname: Kim
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Yoon-Tae
authors.initials: YT
authors.lastname: Jeen
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yoon-Tae Jeen, Hong Sik Lee, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Korea University Medical Center, Seoul 02841, South Korea.
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
mesh_terms: D018952:Antigens, CD34 / Q000378:metabolism; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D020699:Gastroscopes; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D019009:Proto-Oncogene Proteins c-kit / Q000378:metabolism; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D013396:Suction; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34; D019009:Proto-Oncogene Proteins c-kit
keywords: En bloc resection; Endoscopic resection; Gastrointestinal stromal tumor; Subepithelial tumor; Submucosal tumor