Endoscopy 2018; 50(04): S22-S23
DOI: 10.1055/s-0038-1637092
ESGE Days 2018 oral presentations
20.04.2018 – Video session 3
Georg Thieme Verlag KG Stuttgart · New York

HYBRID NOTES – COMPLETE ENDOSCOPIC RESECTION OF THE GASTRIC WALL ASSISTED BY LAPAROSCOPY IN A GASTRIC FUNDUS GIST

J Fernandes
1   Hospital Santa Luzia, ULS Alto Minho, Gastroenterology, Viana do Castelo, Portugal
2   Centro Hospitalar Cova da Beira, Covilhã, Portugal
,
D Libânio
1   Hospital Santa Luzia, ULS Alto Minho, Gastroenterology, Viana do Castelo, Portugal
,
L Lopes
3   Hospital Santa Luzia, ULS Alto Minho, Viana do Castelo, Portugal
4   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho Researcher, ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

The authors present the case of a 33-year-old woman with a 15-mm subepithelial lesion located in the gastric fundus.

In echoendoscopy, this was a homogeneous hypoechogenic lesion without cystic areas, with a 12 mm greater axis, depending on the muscularis propria, compatible with gastrointestinal stromal tumor (GIST). After informing the patient of the malignant potential of the lesion, she rejected periodic follow-up and opted for immediate resection. After a multidisciplinary meeting, it was decided to perform the endoscopic resection assisted by laparoscopy, in order to minimize the resected extension.

The procedure was initiated by laparoscopy with clamping of the jejunum, to avoid intestinal distension during endoscopic dissection of the submucosa (ESD). Subsequently, the dissection of the subepithelial fundic lesion was made using IT-Knife 2 (Olympus), and it was found to be in continuity with the muscularis propria. A circular incision of the muscularis propria/serosa was performed under laparoscopic control. Subsequently the lesion was externalized through the oral cavity; the laparoscopic perforation was closed with an endo-GIA 60. There were no adverse events related to this procedure. Histopathological examination showed a benign GIST, with an R0 resection.

Laparoscopic wedge resection with linear stapler is widely accepted in the treatment of gastric GIST. Although surgery may not be complex, it may involve excessive removal of normal gastric tissue. To avoid this, the authors describe a combined technique with complete endoscopic resection of the gastric wall assisted by laparoscopy. They also emphasize the role that this hybrid approach can play in excision of lesions, which access by conventional laparoscopy is technically difficult, given its location near the esophagogastric junction.