Submucosal tunneling endoscopic resection of gastric gastrointestinal stromal tumors: technical tips for optimal outcomes
6 affiliations
- 1Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- 2Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah, USA
- 3Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- 4Department of Medicine, Boston Medical Center–Brighton, Boston, Massachusetts, USA
- 5Harvard Medical School, Boston, Massachusetts, USA
- 6Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; Corresponding author: Hiroyuki Aihara, MD, PhD, Director of Tissue Resection Program, Gastroenterology, Hepatology, and Endoscopy Brigham and Women’s Hospital, 75 Francis St, Boston, Massachusetts 02115, USA.
Abstract
Background and Aims: Submucosal tunneling endoscopic resection (STER) represents a minimally invasive therapeutic technique for selected gastric GI stromal tumors (GISTs). However, procedural success is highly dependent on lesion characteristics and technical execution. We present a structured approach to gastric GISTs and a key technical consideration for successful STER by contrasting an unsuccessful case and a successful case. Methods: Two patients with gastric GISTs arising from the muscularis propria underwent attempted STER. Preprocedural EUS was performed to assess lesion size, depth, and growth pattern. Procedural steps, including tunnel strategy, scope orientation, and adjunctive maneuvers, were analyzed to identify factors influencing technical success. Results: In the first case, STER was performed with a long tunnel; however, because of the exophytic nature of the GIST, it failed to be visualized, leading to procedural abortion. In contrast, the second case demonstrated successful STER using a short tunnel approach, a horizontal mucosal incision to facilitate specimen extraction, careful scope reorientation to establish a tangential dissection plane, and snare-assisted confirmation of complete tumor mobilization. A mucosal tear occurred secondary to forward pressure during dissection and was managed with endoscopic suturing without adverse events. Conclusions: Successful STER for gastric GISTs can result from meticulous preprocedural EUS assessment, horizontal incision with short tunnel creation, and selective use of adjunctive techniques. Awareness of these technical principles may improve procedural success and safety.
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BibTeX
@article{abdulrahmanqatomah2026submucosal,
title = {{Submucosal tunneling endoscopic resection of gastric gastrointestinal stromal tumors: technical tips for optimal outcomes}},
author = {Abdulrahman Qatomah, MD and Daryl Ramai, MD, MSc, MPH and Talal Alenezi, MD and Dimo Dimitrov, MD and Mohammad Almesned, MD, MSc and Hiroyuki Aihara, MD, PhD},
journal = {VideoGIE},
year = {2026},
month = nov,
doi = {10.1016/j.vgie.2026.06.012},
url = {https://doi.org/10.1016/j.vgie.2026.06.012},
note = {CC BY},
}
RIS
TY - JOUR
TI - Submucosal tunneling endoscopic resection of gastric gastrointestinal stromal tumors: technical tips for optimal outcomes
AU - Abdulrahman Qatomah, MD
AU - Daryl Ramai, MD, MSc, MPH
AU - Talal Alenezi, MD
AU - Dimo Dimitrov, MD
AU - Mohammad Almesned, MD, MSc
AU - Hiroyuki Aihara, MD, PhD
PY - 2026
DA - 2026/11/08
JO - VideoGIE
DO - 10.1016/j.vgie.2026.06.012
UR - https://doi.org/10.1016/j.vgie.2026.06.012
AB - Background and Aims: Submucosal tunneling endoscopic resection (STER) represents a minimally invasive therapeutic technique for selected gastric GI stromal tumors (GISTs). However, procedural success is highly dependent on lesion characteristics and technical execution. We present a structured approach to gastric GISTs and a key technical consideration for successful STER by contrasting an unsuccessful case and a successful case. Methods: Two patients with gastric GISTs arising from the muscularis propria underwent attempted STER. Preprocedural EUS was performed to assess lesion size, depth, and growth pattern. Procedural steps, including tunnel strategy, scope orientation, and adjunctive maneuvers, were analyzed to identify factors influencing technical success. Results: In the first case, STER was performed with a long tunnel; however, because of the exophytic nature of the GIST, it failed to be visualized, leading to procedural abortion. In contrast, the second case demonstrated successful STER using a short tunnel approach, a horizontal mucosal incision to facilitate specimen extraction, careful scope reorientation to establish a tangential dissection plane, and snare-assisted confirmation of complete tumor mobilization. A mucosal tear occurred secondary to forward pressure during dissection and was managed with endoscopic suturing without adverse events. Conclusions: Successful STER for gastric GISTs can result from meticulous preprocedural EUS assessment, horizontal incision with short tunnel creation, and selective use of adjunctive techniques. Awareness of these technical principles may improve procedural success and safety.
SN - 2468-4481
ER -