Minimally Invasive Intragastric Approach to Gastroesophageal Junction Pathology.

BACKGROUND: A minimally invasive intragastric approach to the gastroesophageal junction (GEJ) allows resection of intramural pathology while avoiding disruption of the lower esophageal sphincter (LES) and vagi. Few surgeons use this approach, thus little is known regarding its indications, feasibility, technical aspects, complication profile, and long-term outcomes. We reviewed our experience with this technique.

METHODS: We performed a retrospective review of a prospectively maintained IRB-approved database covering the time period 01/01/2005-8/01/2017. Indications, operative details, postoperative complications, and outcomes were assessed.

RESULTS: There were 12 patients identified. Mean patient age was 51.9 years. The indications for resection included 10 symptomatic leiomyomas, 1 gastrointestinal stromal tumor (GIST) and 3 cancers of the GEJ. Mean and median length of stay was 4.9 and 2.5 days, respectively. There were two postoperative esophageal leaks managed with laparoscopic repair. Of the 3 patients with cancer, 2 underwent an R0 resection while one underwent an R1 resection. There were no other complications or recurrences. Mean follow up was 6.0 years (range 0.5-12.6); no patients developed stricture or symptomatic gastroesophageal reflux upon long term follow up.

CONCLUSIONS: Resection of selected intramural GEJ pathology using a minimally invasive trans-gastric approach can be performed safely with acceptable morbidity and good long-term results. The approach allows preservation of the LES and vagi, a potential advantage compared to other surgical alternatives to resection in this region.