Transgastric and Reverse Sleeve Resection of Gastric Submucosal Tumors: Analysis of 7 Cases

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.