Transgastric and Reverse Sleeve Resection of Gastric Submucosal Tumors: Analysis of 7 Cases
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O RIGINAL A R T I CL E
Transgastric and Reverse Sleeve Resection of Gastric Submucosal Tumors: Analysis of 7 Cases Erol Piskin, Tahsin Dalgic, Yigit Mehmet Ozgun, Abdullah Senlikci, Osman Aydın, Erdal Birol Bostancı
Abstract Background: Gastric submucosal tumors (SMTs) are tumors originating in the subepithelial layer of the stomach.
Excision of the tumors in the esophagogastric junction and lesser curvature of the stomach by simple wedge resection is technically difficult and the risk of complications is high. Here, we present a series of cases of submucosal lesions located in the esophagogastric junction and lesser curvature which were successfully treated by reverse sleeve gastrectomy or combined endoscopic laparoscopic surgery (CELS). Methods: Between January 2018 and February 2019, 7 patients with gastric SMTs in the esophagogastric junction
or lesser curvature underwent surgery at the Turkiye Yuksek Ihtisas Training and Research Hospital. The patients were evaluated in terms of age, gender, additional disease, localization, symptoms, operation type, operation time, intraoperative complications, conversion requirement, pathology, negative surgical margin (R0) resection, tumor size, time of oral intake, post-operative complications and duration of hospitalization. Results: The tumor was located in the cardia in three patients, in the lesser curvature in three and in the corpus posterior wall in one patient. In three of the cases, preoperative dysphagia was present, in one dyspepsia and in one upper gastrointestinal (GI) bleeding. Transgastric CELS was performed in 4 cases and laparoscopic reverse sleeve gastrectomy in three cases. One patient developed pneumonia postoperatively, but no other complications were observed. Histopathological examination showed leiomyoma in 3 cases and GI stromal tumor (GIST) in four. In all patients surgical margins were negative. Conclusions: Transgastric CELS and reverse sleeve gastrectomy can be performed safely for gastric submucosal
lesions located in the esophagogastric junction and lesser curvature. Key words: Transgastric resection; combined endoscopic laparoscopic surgery; reverse sleeve gastrectomy; gastric sub-
mucosal tumors
Introduction Gastric submucosal tumors (SMTs) are tumors that originate in the subepithelial layer and are covered with normal gastric mucosa [1]. They are identified with an incidence of 0.36% during upper gastrointestinal (GI) endoscopy [2]. SMTs in the GI tract are most commonly located in the stomach (40-60%), followed by the small intestine (30-35%) and the colon and rectum (5-16%) [3]. Endoscopic examination alone cannot differentiate between histological types of SMTs, such as GI stromal tumor (GIST) and leiomyoma. Endoscopic mucosal biopsy is not usually performed because of the normal appearance of the mucosa over the SMT, and biopsy is a potential risk Ankara City Hospital, Gastroenterology Surgery Department, Ankara,Turkey Corresponding author: Abdullah Senlikci Ankara City Hospital, Gastroenterology Surgery Department, Ankara, Tur
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