Endoscopic submucosal excavation for a small rectal gastrointestinal stromal tumor with serosal layer preservation: a case report

Key Takeaways for GI Nurses

• Endoscopic submucosal excavation represents an emerging minimally invasive technique for removing small rectal gastrointestinal stromal tumors (GISTs) while preserving critical serosal layer integrity
• This procedure offers a middle-ground approach between traditional endoscopic resection and surgical intervention, potentially reducing patient morbidity and recovery time
• Nurses should be prepared for specialized instrumentation and procedural requirements that differ from standard polypectomy or EMR techniques
• Post-procedure monitoring protocols may need adjustment to assess for complications specific to deeper submucosal excavation procedures

Clinical Relevance

This case report highlights a significant advancement in endoscopic treatment options for rectal GISTs, which traditionally required surgical resection due to their submucosal location and risk of perforation. For endoscopy nurses, this technique expands the scope of procedures performed in the GI suite and requires familiarity with advanced endoscopic instruments and techniques. The preservation of the serosal layer is particularly important as it maintains rectal wall integrity while achieving complete tumor removal, potentially reducing the risk of perforation and subsequent surgical intervention.

From a nursing practice perspective, this procedure demands enhanced pre-procedural preparation including detailed patient assessment for anatomical considerations and tumor characteristics. Nurses must be proficient in managing specialized equipment for submucosal excavation, which may include advanced electrocautery devices, injection needles for submucosal lifting, and hemostatic agents. The technique also requires heightened intraoperative vigilance for signs of complications, particularly perforation or bleeding, given the deeper level of tissue manipulation compared to standard endoscopic procedures.

Unit operations may be impacted through longer procedure times and the need for additional recovery monitoring protocols. Post-procedure care should include careful assessment for delayed complications such as bleeding, perforation, or infection. This case report also underscores the importance of multidisciplinary collaboration between endoscopy, pathology, and surgical teams, as proper tissue handling and specimen orientation become critical for accurate histopathological assessment and treatment planning.

Bottom Line

Endoscopic submucosal excavation with serosal preservation represents a promising minimally invasive option for small rectal GISTs that endoscopy nurses should understand as it may reduce patient morbidity compared to surgical approaches. However, this advanced technique requires specialized training, equipment familiarity, and enhanced monitoring protocols to ensure safe implementation and optimal patient outcomes in the endoscopy setting.