World’s first endoscopic gastrectomy performed at IRCCS ISMETT

A submucosal tumor was radically removed from a patient with a full-thickness-technique endoscopic procedure, without resorting to traditional surgery. The procedure was carried out at IRCCS ISMETT, in Palermo. This is the first time in the world that this technique has been utilized.  Until now, this kind of procedure has always been performed surgically, and the literature reports very few attempts at an endoscopic approach. In China a few similar procedures have been performed, but with obsolete suture techniques.

The patient was a 51-year-old woman, and the procedure was made possible thanks to a new endoscopic suture system, which allows stitching of the hole made during the operation.  The patient underwent a true wedge-shaped gastrectomy via endoscopy, through which the tumor she had in her stomach was totally removed.

The two main phases of the procedure: resection and suture. Resection was carried out with a miniaturized endoscopic electrosurgical scalpel that removes the tumor and the adjacent gastric wall, thus rendering the procedure oncologically radical. However, this type of gastrectomy creates a large hole in the stomach, which traditionally has not been possible to manage endoscopically.  The truly innovative procedure was performed in the second phase: thanks to a new-generation endoscopic suture, the gastric wall was closed without creating holes in the belly or using abdominal drainage.

The possibility of intervening via endoscopy opens new prospects: intervention on lesions that until now could be operated only via surgery, reduction of post-operative pain, no cutaneous scars, and shorter hospital stay.

The procedure was carried out by Dr. Antonino Granata and Dr. Mario Traina. The patient was discharged only three days after the procedure. “For years we have been waiting for an effective endoscopic tool to suture the intestinal wall from the endoluminal side, and today this has become a reality,” explains Dr. Granata. “The technique used at ISMETT is consonant with the modern therapeutic approach, which will increasingly involve minimally invasive techniques, such as endoscopic techniques, instead of traditional surgery. This will allow the patient a quicker recovery and limit risks related to surgery, as well as decrease health care expenses.”

The IRCCS ISMETT team works toward the development of minimally invasive techniques that allow treating pathologies that in the past could only be treated by surgery. Last year, the institute was the first in Europe to perform a gastro-entero-anastomosis via endoscopy of a duodenal neoplastic obstruction.