Endoscopic en bloc resection of an exophytic gastrointestinal stromal tumor with suction excavation technique

Figure 1 Endoscopic view of the lesion.

Figure 2 Endoscopic ultrasound. Endoscopic ultrasonography showed a heterogenic hypoechoic mass with extraluminal growth originating from the muscularis propria layer.

Figure 3 Abdominal computerized tomography scan showing the 3. 5 cm × 2.5 cm tumor with exophytic growth.

Figure 4 Illustration of the endoscopic suction excavation technique. A: After submucosal injection of sodium hyaluronate, a circumferential incision and removal of the overlying mucosa were performed; B, E: Careful muscular dissection between the tumor and serosa with a hook knife; C, F: Endoscopic suction using the end of a cap-fitted endoscope attached to the tumor; D, G: Submucosal injection of sodium hyaluronate; H: Tumor fully extracted after repeated careful dissection and endoscopic suction.

Figure 5 Tumor was exposed after removing the overlying mucosa.

Figure 6 Extraction showing no perforation.

Figure 7 Extracted tumor after repeated muscular dissection and endoscopic suction.

Figure 8 Endoscopic submucosal dissection scar after 5 years.