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Hybrid Push-Pull Endoscopic and Laparoscopic Full-Thickness Resection for the Minimally Invasive Management of Gastric Gastrointestinal Stromal Tumors (GIST)
Paul T. Reynolds^*1, Melinda M. Lewis², Andrew S. Ross³, Shishir K. Maithel⁴, Flavio G. Rocha⁵, Field F. Willingham^1
1Medicine, Division of Digestive Diseases, Emory University, Atlanta, GA; ²Pathology, Division of Cytology, Emory University, Atlanta, GA; ³Medicine, Section of Gastroenterology, Virginia Mason Medical Center, Seattle, WA; ⁴Surgery, Division of Surgical Oncology, Emory University, Atlanta, GA; ⁵Surgery, Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA

Gastrointestinal stromal tumors (GISTs) arising in the stomach that are highly endophytic or in anatomically complex locations pose a challenge to standard laparoscopic wedge resection and may require complex procedures resulting in extensive gastric tissue removal. Endoscopic resection alone may leave behind tumor for GISTs arising in the muscularis propria or deeper. A push-pull modification of the hybrid endoscopic-laparoscopic approach (mean operative time 162 minutes) is shown here in a four patient case series to be a safe, effective alternative to standard methods for selected GISTs in order to minimize gastric tissue removal while still allowing for a full-thickness, R0 resection.

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