Ashwini Kumar, MD, Kent Van Sickle. Uthscsa.
We present a case of submucosal mass at GE junction, which was confirmed with EGD as well as an endoscopic ultrasound.
Patient is a 47 yo morbidly obese female, with significant history of reflux disease, OSA.
She has multiple previous abdominal surgeries including a open appendectomy, sigmoid colectomy with colovesicular fistula takedown (from diverticutitis), laparoscopic cholecystectomy, and a ventral incisional hernia repair with mesh.
During follow up with EGD, the mass was found to be significantly increased in size, which was concerning.
Dr. Rosen and Dr. Heniford have suggested a combination of endoscopic and a laparoscopic approach for resection of gastric and GE junction lesions.
Given patients morbid obesity and multiple high risk comorbidities, a decision was made to proceed with a laparoscopic transgastric resection of this submucosal mass.
Intraoperatively, the mass was found to be significantly larger (4.5cm) than anticipated with EGD and endoscopic ultrasound, and was extending cephalad towards esophagus. Surgery was difficult primarily due to severe dense adhesions, but went uneventfully.
Patient did well postoperatively. She was started on clear liuid diet on POD#1, and was advanced. She was discharged to home on POD#2. Pathology showed Leiomyoma.
References:
1. Endoluminal gastric surgery: the modern era of minimally invasive surgery. Rosen MJ, Heniford BT. Surg Clin North Am. 2005 Oct;85(5):989-1007, vii.
2. Combined laparoscopic endoscopic procedures. Rosen MJ, Ponsky J. Gastrointest Endosc Clin N Am. 2007 Jul;17(3):521-32, vi.
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