EUS-assisted band ligation of small duodenal stromal tumors and follow-up by EUS

BackgroundDuodenal GI stromal tumors (GISTs), with potential for malignant transformation, arise in muscularis propria. It is difficult to endoscopically resect lesions in the muscularis propria by using standard electrosurgical techniques.ObjectivesOur purpose was to investigate the efficacy of a new method for resection of these tumors, EUS-assisted band ligation.DesignProspective study.SettingShenjing Hospital of China Medical University.PatientsNineteen elderly or high surgical risk patients with small duodenal GISTs.InterventionA standard endoscope with a transparent cap attached to the tip was used. The cap was placed over the lesion, maximum sustained suction was applied, and an elastic band was released around the base. EUS was used to determine whether the hypoechoic mass was confined completely by the band.Main Outcome MeasurementsBeginning 2 weeks after banding, the lesions were observed endoscopically once per week until healing was complete. Thereafter, all patients underwent EUS every 2 to 3 months on schedule.ResultsThe tumors sloughed completely. The mean time required for complete healing after band ligation was 4.7 weeks. Bleeding occurred in 2 patients 7 days after ligation because the lesion sloughed. The bleeding was self-limiting and not life threatening. No perforation or other complications occurred. Follow-up ranged from 18 to 63 months, during which time no recurrence was observed.LimitationNew technique with limited data.ConclusionEUS-assisted band ligation with systematic follow-up by EUS is an effective and safe treatment for small duodenal GISTs.