Clin Endosc.  2016 Sep;49(5):475-478. 10.5946/ce.2016.002.

Non-Exposed Endoscopic Wall-Inversion Surgery for Gastrointestinal Stromal Tumor of the Stomach: First Case Report in Korea

• Kim DW
• Kim JS
• Kim BW
• Jung JY
• Kim GJ
• Kim JJ

• KMID: 2356056
• DOI: http://doi.org/10.5946/ce.2016.002

Abstract

Laparoscopic wedge resection of the stomach is a widely accepted treatment for primary resectable gastrointestinal stromal tumors (GISTs). However, it is difficult to determine the appropriate incision line from outside of the stomach, and many attempts have been made to avoid unnecessary resection of unaffected gastric tissues. Recently a technique called non-exposed endoscopic wall-inversion surgery (NEWS) was introduced to avoid exposure of GIST to the peritoneum. Here, we describe the first published case of NEWS for GIST of the stomach practiced in Korea.

Keyword

Gastrointestinal stromal tumors; Stomach; Endoscopy; Laparoscopy

MeSH Terms

Endoscopy
Gastrointestinal Stromal Tumors*
Korea*
Laparoscopy
Peritoneum
Stomach*

Figure

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  Fig. 1. (A) Initial gastroscopy. The image shows a subepithelial lesion, approximately 2.0×1.5 cm in size, at the greater curvature side of the fundus base (arrow). (B) Endoscopic ultrasound shows that the lesion originated from the 4th muscle layer with a homogeneous and hypoechoic pattern (arrow).

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  Fig. 2. Abdomen computed tomography. The image shows a subepithelial lesion protruding into the gastric lumen (arrow).

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  Fig. 3. Laparoscopic view. (A) The image shows the lesion protruding slightly into the peritoneal cavity (arrow). (B) Electrocautery of the circumferential seromuscular incision. (C) Suture of the seromuscular layers. (D) Complete suturing of the serosal surface (arrow).

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  Fig. 4. (A) The inverted lesion protruding into the gastric lumen. (B) Submucosal dissection is performed with a dual knife. (C) Suture line during submucosal dissection (arrow). (D) Complete removal of the lesion. (E) The mucosal side is closed with clips. (F) The removed lesion measures 2.0×1.5 cm in size.

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  Fig. 5. Immunohistochemistry of the resected lesion. (A) Strong staining of CD34 is observed (×200). (B) Strong staining of CD117 (C-kit) is observed.

Reference

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