Endoscopic Hemostasis using Endoloop for Bleeding Gastric Stromal Tumor

An 80-year-old man presented to our unit with a 2-day history of tarry stool. On admission his blood pressure was 100/60 mm Hg and pulse rate 100 per minute. The initial hematocrit was 30%. Urgent upper endoscopy revealed an active bleeding arising from an ulcer crater over a polypoid submucosal tumor situated at the gastric fundus (Figure A). Endoscopic hemostasis was achieved by application of the endoloop. An endoloop ligation was performed with standard, single-accessory channel endoscope in a retroflected position. After correctly placing the loop, the loop was then tightened around the tumor base (Figure B). Tumor tissue protruded through the ulcerated top of the lesion. There was no clinical recurrence of bleeding. The patient subsequently underwent elective wedge resection of the tumor. The resected tumor measured 45 × 45 × 50 mm. Histological and immunohistochemical studies on the surgical resection specimen revealed gastrointestinal stromal tumor (GIST) with low malignant potential (Figures C and D). The postoperative course was uneventful and the patient was discharged on postoperative day 12.

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