Percutaneous endoscopic intragastric surgery: an organ preserving approach to submucosal tumors at esophagogastric junction

Abstract

As an organ preserving option in the treatment of submucosal tumor found at the esophagogastric junction (EGJ), percutaneous endoscopic intragastric surgery (PEIGS) plays an important role, while it is not commonly performed and there have been very few reports on this unique operation. The current authors have been performing PEIGS since 1993 and have reported on its short- and long-term outcomes from one of the world largest series. Herein its confusing terminology is discussed and techniques of three different types of PEIGS (original PEIGS, single incision PEIGS, and needlescopic PEIGS) are precisely described. Although reports on clinical outcomes of PEIGS have been rarely published, both short-term and long-term outcomes seem acceptable, as far as we review our own experiences and the past literatures. PEIGS needs to be accessed by the data from larger series or RCT to be further justified and spread for the patients with submucosal tumors at EGJ to salvage their stomach.

Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor

“…There is another laparoscopic technique designed to resect tumors by gastrotomy, which can be divided into two types of surgery, transgastric and intragastric surgery . In transgastric surgery, an anterior gastric incision is made, and the tumor is removed under a good visual field through the incision .…”

“…In transgastric surgery, an anterior gastric incision is made, and the tumor is removed under a good visual field through the incision . Intragastric surgery involves direct introduction of the ports into the gastric cavity and removal of the tumor intragastrically . This surgery is not so popular, but causes no damage to the perigastric tissue and has a minimum risk of deformity …”

“…Intragastric surgery involves direct introduction of the ports into the gastric cavity and removal of the tumor intragastrically . This surgery is not so popular, but causes no damage to the perigastric tissue and has a minimum risk of deformity …”

“…19,20,23,24 There is another laparoscopic technique designed to resect tumors by gastrotomy, which can be divided into two types of surgery, transgastric and intragastric surgery. 18,25,26 In transgastric surgery, an anterior gastric incision is made, and the tumor is removed under a good visual field through the incision. 18 Intragastric surgery involves direct introduction of the ports into the gastric cavity and removal of the tumor intragastrically.…”

“…18 Intragastric surgery involves direct introduction of the ports into the gastric cavity and removal of the tumor intragastrically. 25,26 This surgery is not so popular, but causes no damage to the perigastric tissue and has a minimum risk of deformity. 26 The hybrid approach includes LECS, 13,14,27 non-exposed endoscopic wall-inversion surgery (NEWS), 28,29 and closed LECS.…”