• GIST
• Gastrointestinal stromal tumor
• Partial gastrectomy
• Tyrosine kinase inhibitor
• Wedge gastrectomy

• Gastrointestinal Stromal Tumors/surgery
• Gastrointestinal Stromal Tumors/pathology
• Humans
• Gastrectomy/methods
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology

• Gastrointestinal stromal tumors
• Laparoscopic surgery
• Minimally invasive surgery

• Humans
• Treatment Outcome
• Laparoscopy/methods
• Gastrointestinal Stromal Tumors/surgery
• Gastrointestinal Stromal Tumors/pathology
• Gastrectomy/methods
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Surgical Wound
• Retrospective Studies

• gastric subepithelial tumor
• gastrointestinal stromal tumor
• laparoscopic wedge resection

• GIST
• Gastrointestinal stromal tumors
• NET
• Neuroendocrine tumors
• Pediatric oncology
• Pediatric surgery

• Efficacy
• gastric stromal tumours
• gastroscopy meta-analysis
• laparoscopy
• safety
• system review

A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection.

A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed.

All laparoscopic procedures were successfully performed without requiring a major gastrectomy. The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication.

LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.

• Esophagogastric junction
• Gastric cancer
• Gastrointestinal stromal tumor
• Intragastric surgery
• Laparoscopic surgery
• Submucosal gastric lesion

• Efficacy
• gastric stromal tumours
• gastroscopy
• laparoscopy
• meta-analysis
• open resection
• safety

Submucosal tumors (SMTs) of different etiologies exist from esophagus to rectum. Esophagogastric junction (EGJ) is one of the known difficult locations for tumor resection. Although minimally invasive surgery (MIS) is a well-established approach for gastrointestinal surgery, there is no consensus that MIS for resection of SMTs around EGJ is superior to laparotomy. We tried to clarify the factors that determine the surgeons’ choices between these two approaches.

From January 2002 to June 2016, 909 patients with SMTs underwent resection in our department. Among them, 119 patients (13%) had SMTs around EGJ were enrolled by retrospective review. The clinicopathological features and tumor-related parameters were reviewed and analyzed.

The cohort was stratified into three groups according to the extent of gastrectomy and surgical approaches. The three groups are as following: major gastrectomy (n = 13), minor gastrectomy by laparotomy (n = 51), and minor gastrectomy with MIS (n = 55). The average tumor size was significantly larger in the major gastrectomy group than in the two minor gastrectomy groups; however, there was no difference between the two minor gastrectomy groups (5.33 cm, 4.07 cm, and 3.69 cm, respectively). The minor gastrectomy with MIS required least hospital stay and operation duration also. We re-stratify the two minor gastrectomy groups (n = 106) according to the orientation of SMTs around the EGJ into 4 zones. Most of SMTs located on the greater curvature side of the EGJ were resected with MIS (82% versus 18%), whereas SMTs in the other zones were resected more often by laparotomy (59% versus 41%). There was no surgical mortality within the cohort, while minor gastrectomy with MIS yielded least number of leakages among the three groups.

For SMTs around the EGJ, larger tumors (diameter of more than 5 cm) are more likely to be resected with major gastrectomy. To resect SMTs around the EGJ in a wedge-like (minor gastrectomy) fashion, tumors located other than the greater curvature side were more often resected by laparotomy. However, MIS yielded acceptable safety and surgical outcomes compared to conventional laparotomy for SMTs around the EGJ of the same size.

• Esophagogastric junction
• Gastrointestinal stromal tumor
• Gastrointestinal tract
• Minimally invasive surgery
• Submucosal tumor

• ct
• gastroesophageal junction
• gastrointestinal stromal tumor
• leiomyoma

• Adult
• Aged
• Analysis of Variance
• China
• Female
• Gastrointestinal Stromal Tumors/etiology
• Gastrointestinal Stromal Tumors/physiopathology
• Humans
• Leiomyoma/complications
• Leiomyoma/physiopathology
• Male
• Middle Aged
• ROC Curve
• Tomography, X-Ray Computed/methods

To compare the outcomes of submucosal tunneling endoscopic resection (STER) and submucosal excavation (ESE) for the treatment of submucosal tumors (SMTs) arising from the muscularis propria (MP) at the esophagogastric junction (EGJ).

A retrospective analysis of patients with SMTs at EGJ who underwent STER and ESE from October 2011 to October 2017 was performed. The outcomes evaluated were operation time, complete resection rate, adverse events, and tumor recurrence.

Ninety patients were included in this study. Complete resection rates in the STER group were higher than those of the ESE group (100 vs. 92%, p < 0.05). For tumors ≤15 mm, both techniques achieved 100% complete resection rate; but for tumors > 15 mm, complete resection rate was higher in the STER group than the ESE group (100% vs. 77.8%, p < 0.05). Subgroup analyses revealed that the operation time of STER for in cardiac-gastric group was longer than that for ESE (145.14 ± 42.43 min vs. 70.32 ± 39.84 min, p <  0.05). The air leakage symptoms were more frequent in STER group (90.9% vs. 50.0%, p < 0.05). No tumor recurrence occurred in both the STER and ESE groups.

For SMTs ≤15 mm, both STER and ESE have similar satisfactory therapeutic outcomes. However, in the cardiac-gastric subgroup, STER had a longer operative time compared to the ESE procedure. For SMTs > 15 mm, STER is the preferred choice due to its higher complete resection rate.

• Endoscopic submucosal excavation
• Esophagogastric junction
• Muscularis propria
• Submucosal tumor
• Submucosal tunneling endoscopic resection

• Adjuvant therapy with imatinib
• Endoscopic resection
• Gastric gastrointestinal stromal tumors
• Operative complications
• Postoperative course
• Surgical resection

• Clinicopathological features
• Epidemiology
• Overall survival
• Primary small gGIST
• Prognosis

• cardia
• endogenous mucosal tumors
• intragastric
• total laparoscopic

• Esophagogastric junction
• Muscularis propria
• Submucosal tumors
• Submucosal tunneling endoscopic resection

• Adult
• Aged
• Endoscopic Mucosal Resection/methods
• Esophageal Neoplasms/surgery
• Esophagogastric Junction/surgery
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Treatment Failure

• Esophagogastric junction
• Gastrointestinal stromal tumors
• Laparoscopic surgery
• Various fashions

• Endoscopic resection
• gastrointestinal stromal tumors
• laparoscopic resection
• meta-analysis
• systematic review

• Gastric submucosal tumor
• endoluminal surgery
• esophagogastric junction (EGJ)
• intragastric surgery
• laparoendoscopic surgery
• transgastric surgery

• Laparoscopic
• gastrointestinal stromal tumor (GIST)
• submucosal tumor (SMT)

• Esophagogastric junction
• muscularis propria layer
• submucosal tumor
• submucosal tunneling endoscopic resection technique

• Bariatric
• Histologic abnormalities
• Leiomyoma
• Sleeve
• Transgastric

• Aged
• Bariatric Surgery/methods
• Esophagogastric Junction/surgery
• Female
• Gastrectomy/methods
• Humans
• Incidental Findings
• Laparoscopy
• Leiomyoma/surgery
• Obesity, Morbid/surgery
• Stomach/surgery
• Stomach Neoplasms/surgery

Various laparoscopic wedge resection (LWR) techniques requiring gastrotomy for gastrointestinal stromal tumors (GISTs) of the stomach have been applied to facilitate tumor resection and preserve the remnant gastric volume. However, there is the possibility of cancer cell dissemination during these procedures. The aim of this study was to assess the oncologic safety of LWR with gastrotomy (LWR-G) compared to LWR without luminal exposure.

Clinicopathologic and operative results of 193 patients who underwent LWR for gastric GIST were retrospectively analyzed from 2003 to 2013. We stratified the patients into two groups: LWR-G and LWR without gastrotomy (LWR-C). Clinicopathologic features, short-term outcomes, and long-term outcomes were compared.

A total of 26 patients underwent LWR-G, and 167 patients underwent LWR-C. The LWR-G group showed significantly more anterior wall-located (n=10, 38.5%), intraluminal (n=20, 76.9%), and ulcerative (n=13, 50.0%) tumors than the LWR-C group (n=33, 19.8%; n=96, 57.5%; n=46, 27.5%, respectively). Postoperative short-term outcomes did not differ between the two groups. When tumor staging was compared, no statistical difference was noted. There was no recurrence in the LWR-G group, while 2 patients in the LWR-C group experienced recurrence. The two recurrences in the LWR-C group were found in the liver and in the remnant stomach at 63 and 12 months after the operation, respectively. No gastric GIST-related death was recorded in any group during the study period.

LWR-G for gastric GIST is an oncologically safe procedure even for masses with ulcerations.

• Gastrointestinal stromal tumors
• Laparoscopy
• Recurrence
• Stomach neoplasms

Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors.

Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy.

All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was 139.2±30.9 minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was 7.7±0.8 days.

ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.

• Esophagogastric junction
• Gastric submucosal tumor

Recently, several studies have reported local full-thickness resection techniques using flexible endoscopy for gastric tumors, such as gastrointestinal stromal tumors, gastric carcinoid tumors, and early gastric cancer (EGC). These techniques have the advantage of allowing precise resection lines to be determined using intraluminal endoscopy. Thus, it is possible to minimize the resection area and subsequent deformity. Some of these methods include: (1) classical laparoscopic and endoscopic cooperative surgery (LECS); (2) inverted LECS; (3) combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; and (4) non-exposed endoscopic wall-inversion surgery. Furthermore, a recent prospective multicenter trial of the sentinel node navigation surgery (SNNS) for EGC has shown acceptable results in terms of sentinel node detection rate and the accuracy of nodal metastasis. Endoscopic full-thickness resection with SNNS is expected to become a treatment option that bridges the gap between endoscopic submucosal dissection and standard surgery for EGC. In the future, the indications for these procedures for gastric tumors could be expanded.

• Gastrointestinal stromal tumor
• Early gastric cancer
• Full-thickness resection
• Laparoscopic and endoscopic cooperative surgery
• Sentinel node navigation surgery

Laparoscopic wedge resection is a useful procedure for treating patients with submucosal tumor (SMT) including gastrointestinal stromal tumor (GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery (LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

• Cooperative surgery
• Endoscopy
• Gastrointestinal tumor
• Laparoscopy
• Submucosal tumor

• Gastrectomy
• Laparoscopy
• Stomach neoplasm
• Submucosal tumor
• Surgical stapling
• Tailored approach

• Female
• Gastrectomy/methods
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Humans
• Laparoscopy/methods
• Male
• Middle Aged
• Neurilemmoma/pathology
• Neurilemmoma/surgery
• Retrospective Studies
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome

• Computed tomography
• Gastrointestinal stromal tumors
• Leiomyoma
• Stomach neoplasms
• Subepithelial tumors

Submucosal tumors (SMTs) of the gastrointestinal tract, which may be an occasional finding on routine upper gastrointestinal (GI) endoscopy, represent a diagnostic and therapeutic challenge. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract and have the potential to progress to malignancy. The primary treatment goal for localized GISTs is surgical resection with achievement of a negative margin (R0 resection). This is the effective way to achieve complete treatment. Minimally invasive surgery has become common in the surgical resection of gastrointestinal SMTs. Recent advances in endoscopic technology provide various treatment modalities for gastric SMTs. Moreover, investigators have developed laparoscopic and endoscopic cooperative procedures. In addition, robotic surgery for SMTs is another choice. The purpose of this article is to review recent trends in minimally invasive surgery for gastric SMTs.

• Minimally invasive surgery
• Submucosal tumor
• Endoscopic procedure
• Robot
• Laparoscopic and endoscopic cooperative procedure

Minimally invasive surgery has become common in the surgical resection of gastrointestinal submucosal tumors (SMTs). The purpose of this article is to review recent trends in minimally invasive surgery for gastric SMTs. Although laparoscopic resection has been main stream of minimally invasive surgery for gastrointestinal SMTs, recent advances in endoscopic procedures now provide various treatment modalities for gastric SMTs. Moreover, investigators have developed several hybrid techniques that include the advantages of both laparoscopic and endoscopic procedure. In addition, several types of reduced port surgeries, modification of conventional laparoscopic procedures, have been recently applied to the surgical resection of SMTs. Meanwhile, robotic surgery for SMTs requires further evidence and improvement.

• Minimally invasive
• Surgery
• Submucosal tumor
• Gastrointestinal tract

• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastroscopy/adverse effects
• Humans
• Laparoscopy/adverse effects
• Robotics
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Surgery, Computer-Assisted
• Treatment Outcome

• esophagogastric junction
• gastric submucosal tumor
• laparoscopic and endoscopic cooperative surgery

• endoscopic submucosal dissection (ESD)
• gastric cancer
• gastrointestinal stromal tumor
• laparoscopic surgery
• robotic endoscopic system

Diagnosis of gastric subepithelial tumor (SET) has shown a rapid increase worldwide. Although, until now, endoscopic ultrasound guided procedures such as fine needle aspiration have shown relatively high accuracy in diagnosis of SET, the most important modality for diagnosis and treatment of SETs is complete resection such as endoscopic or surgical resection. However, endoscopic resection or laparoscopic wedge resection alone also has some limitations. Endoscopic resection is difficult to perform in cases of gastric SET located within deep portion of the gastric layer or a relatively large (larger than 25 mm diameter). On the other hand, gastric SET in a difficult location, such as the gastroesophageal junction or pyloric ring is challenging for laparoscopic surgical resection. The hybrid natural orifice transluminal endoscopic surgery (NOTES) technique is a combined method, including the advantages of both laparoscopic resection and endoscopic resection for gastric SETs. This method may be performed safely with reasonable operation times, less bleeding, and adequate resection margin and regardless of tumor size. In particular, in the case of a difficult location for resection, such as the esophagogastric junction or pyloric ring, hybrid NOTES is currently believed to be an ideal treatment method.

• Subepithelial tumor
• Hybrid natural orifice transluminal endoscopic surgery
• Endoscopic ultrasound

• gastric gist
• laparoscopic-endoscopic resection

• Aged
• Cardia
• Combined Modality Therapy
• Female
• Gastrointestinal Stromal Tumors/surgery
• Gastroscopy
• Humans
• Laparoscopy
• Stomach Neoplasms/surgery

Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.

• Gastrointestinal stomal tumors
• Laparoscopy
• Neoadjuvant therapy
• Surgery

• Adult
• Aged
• Decision Making
• Female
• Follow-Up Studies
• Gastrectomy/methods
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Humans
• Laparoscopy
• Male
• Middle Aged
• Neoplasm Staging
• Retrospective Studies
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/surgery
• Treatment Outcome