Abstract
A 74 year old male presenting with iron deficiency anemia had a large (6.6cm) gastrointestinal tumor (GIST) at the esophagogastric junction (EGJ) extending into the lesser curve. Endoscopic resection of GIST of the EGJ can be performed by the submucosal tunneling and endoscopic resection (STER) technique. However, the maximal reported lesion size is currently 3.3cm. Oncologic principles mandate enbloc resection with an intact capsule due to the malignant potential of the lesions. Therefore STER of large GIST is limited by the size of the mucosal tunnel entry. Laparoscopic wedge resection (LWR) techniques of large tumors at the EGJ is technically challenging with a risk of narrowing the lumen at the EGJ with surgical stapling, leading to dysphagia, injury to the lower esophageal sphincter (LES) leading to lifelong reflux and leak at the staple line. Furthermore, esophagogastrectomy may also be required for lesions at the EGJ. STER of such a lesion can release the tumor from the EGJ and facilitate easy access for transgastric laparoscopic resection and technique and avoiding the risks of standard LWR techniques.
Published Version
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