Introduction

Subepithelial lesions (SELs) of the gastrointestinal tract are often incidentally found and can range from benign to potentially malignant tumors. Traditional management includes endoscopic surveillance or resection, but deeper lesions may be difficult to remove endoscopically. Endoscopic Full-Thickness Resection (EFTR) is a minimally invasive technique that allows complete removal of such lesions. We report a case of a subepithelial lesion successfully treated with EFTR, highlighting its diagnostic and therapeutic utility.

Case Description

A 71-year-old man with a medical history of Schatzki ring, arterial hypertension, dyslipidemia, coronary artery disease and psoriasis, was referred for a subepithelial lesion on the greater curvature at the body-antrum junction, diagnosed during an outpatient upper gastrointestinal endoscopy performed for dyspepsia. An endoscopic ultrasound was performed, identifying a well-defined elongated subepithelial lesion, measuring approximately 16x6 mm in size, hypoechoic, heterogeneous, arising from the muscularis propria layer, with features that do not allow the potential malignancy of the lesion to be ruled out, including the distinction between Gastrointestinal Stromal Tumor (GIST) and leiomyoma. Considering these findings, it was decided to excise the lesion by a cap-assisted EFTR technique using the gastroduodenal FTRD® system (Ovesco Endoscopy, Tubingen, Germany). An en-bloc resection was achieved without complications. Histopathological analysis revealed a R0-resection of a solitary inverted hamartomatous polyp. No other hamartomas were detected on colonoscopy, excluding hereditary polyposis syndromes. At 1-month follow-up, the patient remains asymptomatic with no complications.

Conclusion

This case highlights the efficacy and safety of EFTR for the management of gastrointestinal subepithelial lesions allowing complete resection for histopathological purposes. Endoscopic resection as a minimally invasive approach allows for both definitive diagnosis and treatment, avoiding the need for ongoing surveillance, being the size of the lesion the main limitation.