Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injection
Background and Aims: Gastric neuroendocrine tumors (NETs), although rare, are highly vascular subepithelial lesions that can pose significant bleeding risks during endoscopic submucosal dissection (ESD). Traditionally, bleeding is managed intraoperatively with mechanical or thermal hemostasis, but p...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
|
| Series: | VideoGIE |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468448125001195 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849390116268670976 |
|---|---|
| author | Radhika Chavan, MD, DNB, FISG, FASGE Vishal Seth, MD, DM Zaheer Nabi, MD, DNB, FISG, FASGE Dadasaheb Maindad, MD, DNB Harshwardhan Dongre, DNB Sanjay Rajput, MD, DM Akhil Nagpal, MD, DM |
| author_facet | Radhika Chavan, MD, DNB, FISG, FASGE Vishal Seth, MD, DM Zaheer Nabi, MD, DNB, FISG, FASGE Dadasaheb Maindad, MD, DNB Harshwardhan Dongre, DNB Sanjay Rajput, MD, DM Akhil Nagpal, MD, DM |
| author_sort | Radhika Chavan, MD, DNB, FISG, FASGE |
| collection | DOAJ |
| description | Background and Aims: Gastric neuroendocrine tumors (NETs), although rare, are highly vascular subepithelial lesions that can pose significant bleeding risks during endoscopic submucosal dissection (ESD). Traditionally, bleeding is managed intraoperatively with mechanical or thermal hemostasis, but pre-emptive strategies remain underexplored. Here, we report the use of EUS-guided pre-emptive epinephrine injection to minimize the bleeding risk during gastric NET ESD. Methods: To minimize the risk of bleeding during ESD of large gastric NETs, a pre-emptive EUS-guided epinephrine injection was administered at the base of the lesion near the feeder vessel. Results: A 38-year-old female was diagnosed with a large gastric subepithelial lesion during evaluation for upper gastrointestinal bleeding. EUS revealed a large hypoechoic tumor confined to the submucosa with a prominent feeding vessel. Given the predominantly submucosal location, ESD was planned. However, significant bleeding was anticipated due to the large feeder vessel. Therefore, a pre-emptive EUS-guided adrenaline injection (5 mL of 1:10,000 diluted epinephrine) was administered at the base of the lesion after confirming absence of blood return on fine-needle aspiration. Instantaneous pallor of the lesion was observed. ESD was subsequently completed successfully without any bleeding. Conclusions: This case highlights a novel, effective, and safe use of EUS-guided pre-emptive epinephrine injection to minimize bleeding during ESD of vascular gastric NETs. This approach could enhance procedural safety and warrants further prospective evaluation. |
| format | Article |
| id | doaj-art-bcb806ef68644fa8ad6aef844054df70 |
| institution | Kabale University |
| issn | 2468-4481 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | VideoGIE |
| spelling | doaj-art-bcb806ef68644fa8ad6aef844054df702025-08-20T03:41:46ZengElsevierVideoGIE2468-44812025-09-0110946446810.1016/j.vgie.2025.04.010Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injectionRadhika Chavan, MD, DNB, FISG, FASGE0Vishal Seth, MD, DM1Zaheer Nabi, MD, DNB, FISG, FASGE2Dadasaheb Maindad, MD, DNB3Harshwardhan Dongre, DNB4Sanjay Rajput, MD, DM5Akhil Nagpal, MD, DM6Department of Gastroenterology and Advanced Endoscopy, Bharati Vidyapeeth (deemed university), Pune, Maharashtra, India; Corresponding author: Radhika Chavan, MD, DNB, FISG, FASGE, Bharati Vidyapeeth (deemed university), Katraj, Pune, Maharashtra, India.Department of Gastroenterology and Advanced Endoscopy, Bharati Vidyapeeth (deemed university), Pune, Maharashtra, IndiaDepartment of Advanced Endoscopy, AIG, Hyderabad, Telangana, IndiaDepartment of Gastroenterology and Advanced Endoscopy, Bharati Vidyapeeth (deemed university), Pune, Maharashtra, IndiaDepartment of Gastroenterology and Advanced Endoscopy, Bharati Vidyapeeth (deemed university), Pune, Maharashtra, IndiaDepartment of Gastroenterology and Advanced Endoscopy, Ansh Clinic, Ahmedabad, Gujrat, IndiaDepartment of Gastroenterology and Advanced Endoscopy, Bharati Vidyapeeth (deemed university), Pune, Maharashtra, IndiaBackground and Aims: Gastric neuroendocrine tumors (NETs), although rare, are highly vascular subepithelial lesions that can pose significant bleeding risks during endoscopic submucosal dissection (ESD). Traditionally, bleeding is managed intraoperatively with mechanical or thermal hemostasis, but pre-emptive strategies remain underexplored. Here, we report the use of EUS-guided pre-emptive epinephrine injection to minimize the bleeding risk during gastric NET ESD. Methods: To minimize the risk of bleeding during ESD of large gastric NETs, a pre-emptive EUS-guided epinephrine injection was administered at the base of the lesion near the feeder vessel. Results: A 38-year-old female was diagnosed with a large gastric subepithelial lesion during evaluation for upper gastrointestinal bleeding. EUS revealed a large hypoechoic tumor confined to the submucosa with a prominent feeding vessel. Given the predominantly submucosal location, ESD was planned. However, significant bleeding was anticipated due to the large feeder vessel. Therefore, a pre-emptive EUS-guided adrenaline injection (5 mL of 1:10,000 diluted epinephrine) was administered at the base of the lesion after confirming absence of blood return on fine-needle aspiration. Instantaneous pallor of the lesion was observed. ESD was subsequently completed successfully without any bleeding. Conclusions: This case highlights a novel, effective, and safe use of EUS-guided pre-emptive epinephrine injection to minimize bleeding during ESD of vascular gastric NETs. This approach could enhance procedural safety and warrants further prospective evaluation.http://www.sciencedirect.com/science/article/pii/S2468448125001195 |
| spellingShingle | Radhika Chavan, MD, DNB, FISG, FASGE Vishal Seth, MD, DM Zaheer Nabi, MD, DNB, FISG, FASGE Dadasaheb Maindad, MD, DNB Harshwardhan Dongre, DNB Sanjay Rajput, MD, DM Akhil Nagpal, MD, DM Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injection VideoGIE |
| title | Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injection |
| title_full | Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injection |
| title_fullStr | Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injection |
| title_full_unstemmed | Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injection |
| title_short | Minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre-emptive EUS-guided epinephrine injection |
| title_sort | minimizing bleeding risks during gastric neuroendocrine tumor endoscopic submucosal dissection by pre emptive eus guided epinephrine injection |
| url | http://www.sciencedirect.com/science/article/pii/S2468448125001195 |
| work_keys_str_mv | AT radhikachavanmddnbfisgfasge minimizingbleedingrisksduringgastricneuroendocrinetumorendoscopicsubmucosaldissectionbypreemptiveeusguidedepinephrineinjection AT vishalsethmddm minimizingbleedingrisksduringgastricneuroendocrinetumorendoscopicsubmucosaldissectionbypreemptiveeusguidedepinephrineinjection AT zaheernabimddnbfisgfasge minimizingbleedingrisksduringgastricneuroendocrinetumorendoscopicsubmucosaldissectionbypreemptiveeusguidedepinephrineinjection AT dadasahebmaindadmddnb minimizingbleedingrisksduringgastricneuroendocrinetumorendoscopicsubmucosaldissectionbypreemptiveeusguidedepinephrineinjection AT harshwardhandongrednb minimizingbleedingrisksduringgastricneuroendocrinetumorendoscopicsubmucosaldissectionbypreemptiveeusguidedepinephrineinjection AT sanjayrajputmddm minimizingbleedingrisksduringgastricneuroendocrinetumorendoscopicsubmucosaldissectionbypreemptiveeusguidedepinephrineinjection AT akhilnagpalmddm minimizingbleedingrisksduringgastricneuroendocrinetumorendoscopicsubmucosaldissectionbypreemptiveeusguidedepinephrineinjection |