title: Modified laparoscopic intragastric surgery and endoscopic full-thickness resection for gastric stromal tumor originating from the muscularis propria.
abstract: BACKGROUND
  This study aimed to evaluate the feasibility and security of the modified laparoscopic intragastric surgery (MLIGS) and the endoscopic full-thickness resection (EFR) for the treatment of gastric stromal tumors (GSTs) originating from the muscularis propria.
  
  
  METHODS
  The study population was 18 patients with GSTs of the intraluminal muscularis propria layer. Eight were treated by MLIGS performed according to the following procedures: (1) gastroscopy was used to expose and confirm the location of the tumor; (2) a laparoscope light was placed in the cavity using the trocar at the navel, with the remaining two trocars penetrating both the abdominal and stomach walls; (3) the operation was performed in the gastric lumen using laparoscopic instruments with gastroscope monitoring, and the tumor was resected; (4) the tumor tissue was removed orally using a grasping forceps; (5) and the puncture holes and perforation in the stomach were sutured using titanium clips. The remaining 10 patients were treated by EFR, which involved (1) injection of normal saline into the submucosa and precutting of the mucosal and submucosal layer around the lesion, (2) a circumferential incision as deep as the muscularis propria around the lesion, (3) an incision into the serosal layer around the lesion, (4) completion of full-thickness incision to the tumor, (5) closure of the gastric wall defect with clips.
  
  
  RESULTS
  The GSTs all were resected completely. The two groups did not differ significantly in terms of tumor size, hospital stay, or abdominal pain time. But in the MLIGS group, the operation time and blood loss were significantly decreased compared with the EFR group. No postoperative complications occurred in the MLIGS group, whereas one peritoneal abscess occurred in the EFR group. The pathology of all the resected specimens showed GST. No case of implantation or metastasis was found.
  
  
  CONCLUSIONS
  Both MLIGS and EFR are feasible and effective treatments for GSTs from the muscularis propria. Moreover, both are minimally invasive.
authors.affiliation: Department of Endoscopy, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China, wangyulong02@yahoo.com.cn.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Dong
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Wang
authors.forename: Xin-Yong
authors.initials: XY
authors.lastname: Jia
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Guo-Dong
authors.initials: GD
authors.lastname: Li
authors.forename: Yan-Qing
authors.initials: YQ
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome