Endoluminal resection of gastric intestinal stromal tumors (GIST).

Endoluminal surgery, the combination of flexible endoscopy and percutaneous transgastric laparoscopy, has expanded the role of minimally invasive surgery in treating foregut diseases. This imaginative technique blends the skills of endoscopist and laparoscopist. The stomach is well-suited for this technique as it is an expandable, large volume organ readily accessible to a flexible endoscope, and the relative ease of placing endoscopically or laparoscopically-guided percutaneous, transgastric ports provides access for laparoscopic instrumentation. The resection of gastric stromal tumors provides one of the few opportunities to integrate flexible endoscopy and laparoscopy. Proper training in the appropriate indications to utilize endoluminal techniques and familiarity with the multiple modifications from the original intragastric techniques described nearly a decade ago will allow surgeons to approach small, predominately endoluminal gastric stromal tumors with low malignant potential located in the cardia, along the posterior gastric wall, near the gastroesophageal junction or proximal to the pylorus.