A laparoendoscopic approach could become a feasible option to resect some gastrointestinal stromal tumors (GISTs), according to a study recently published in the International Journal of Surgery Case Reports.
“This report aims to help surgeons facing the difficult decision of how to approach small GEJ GISTs avoiding the potential of morbidity from larger anatomical resections, providing the surgeon with additional tools to tackle these difficult tumors,” the authors wrote.
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This case report describes a 70-year-old male who presented with an episode of upper gastrointestinal bleeding complicated with hypovolemic shock secondary to severe hemorrhage. Notably, the patient had a history of previous hospitalization due to another episode of upper gastrointestinal tract hemorrhage in 2020, secondary to a subcardial lesion of 9 mm.
Laboratory tests revealed elevated troponins, and an endoscopic ultrasound evidenced a gastric ulcer of mixed echogenicity, of 16 x 5 mm, in the subcardial location, 2 cm distal to the z line, and with signs of recent bleeding. The patient received proper care with blood transfusions and sclerotherapy of the ulcer with adrenaline. A biopsy at this moment did not report malignancy.
The healthcare team decided to perform a laparoscopic and endoscopic surgical resection of the lesion, with subsequent hemostasis with clips and sclerotherapy. The mucosal defect was closed with endoscopic clips.
The final biopsy showed a GIST greatly reactive for CD117 (C-KIT) and DOG-1, and moderate CD34+ expression, with a ki67 cell proliferation index lower than 1%.
The patient completed the postoperative period without complications and remained with optimal gastrointestinal functions at the 15 and 50-day follow-ups. Although still being monitored by the oncologic surgery service, this case showcases this procedure’s potential ability to cure some GISTs with a less invasive technique and favorable safety profile.
“This is one of the combined laparo-endoscopic techniques available, minimizing the risk of unintentional large resection resulting in deformity and malfunction of the remaining stomach, damaging the nerves, and causing prolonged gastric emptying,” the authors concluded.
Núñez-Rocha R, Pérez V, Urango M, Latiff M, Pinto R, Herrera-Almario G. Laparoscopic assisted surgery for a gastrointestinal stromal tumor (GIST): a case report. Int J Surg Case Rep. Published online January 4, 2023. doi:10.1016/j.ijscr.2022.107871