Single-Stage Non-Exposed Endoscopic Wall-Inversion Surgery and Laparoscopic Pylorus-Preserving Gastrectomy for a Gastric Leiomyoma in the Cardia and Early Gastric Cancer in the Middle Stomach: A Case Report.

Non-exposed endoscopic wall-inversion surgery (NEWS) is a method of endoscopic full-thickness resection without transluminal access. We report a case of simultaneous NEWS and laparoscopic pylorus-preserving gastrectomy (LPPG) for a gastric leiomyoma in the cardia and early gastric cancer (EGC) in the middle stomach. A 56-year-old woman had a 15 mm intraluminal submucosal tumor (SMT) on the posterior wall of the cardia and a type 0-IIc lesion on the greater curvature of the middle stomach. Biopsy suggested the SMT was a leiomyoma or gastrointestinal stromal tumor, and the type 0-IIc lesion was poorly differentiated adenocarcinoma, consistent with EGC. The SMT was located approximately 10 mm distal to the esophagogastric junction, and total gastrectomy was initially considered. However, to avoid extensive gastric resection and preserve gastric function, we performed LPPG for the EGC followed by NEWS for the SMT, achieving minimally invasive, function-preserving surgery. The patient was discharged uneventfully on postoperative day 8.