Benign Esophageal and Gastric Tumors: Laparoscopic Management of Benign Submucosal Tumors

  • Riley K. Kitamura
  • Brian JacobEmail author


Benign submucosal tumors in the proximal GI tract are rare and often asymptomatic. The majority of these tumors are leiomyomas in the esophagus and gastrointestinal stromal tumors in the stomach. While surveillance is a viable option, symptomatic tumors, or those with worrisome characteristics, should be excised. The operative goal is complete resection without altering gastrointestinal function. The surgical approach and technique are dependent on the location of the tumor and whether resection may overly narrow the intestinal lumen (i.e., near the pylorus) or injure nearby structures. Preoperative or intraoperative upper endoscopy can be invaluable to assist in tumor localization. More recently, hybrid laparoscopic and endoscopic submucosal dissection has shown promise in achieving less radical dissections and perhaps avoiding the need for major reconstruction (i.e., Billroth I/II, Roux-en-Y) after the tumor is excised. These techniques are gaining popularity as endoscopic surgery is becoming more commonplace; however, the large studies addressing safety and efficacy are lacking.


Submucosal Benign Gastric Tumors Laparoscopic Endoscopy Resection 


  1. 1.
    Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, Atomi Y. Endoscopic full thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc. 2009;23:1908–13.CrossRefGoogle Scholar
  2. 2.
    Camp P Jr, Lukanich J. Resection of benign tumors of the esophagus. In: Sugarbaker DJ, Bueno R, Colson YL, Jaklitsch MT, Krasna MJ, Mentzer S, Williams M, Adams A, editors. Adult chest surgery. 2nd ed. New York: McGraw-Hill Medical; 2014.Google Scholar
  3. 3.
    Lee CM, Kim H-H. Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach. World J Gastroenterol. 2014;20(36):13035–43.CrossRefGoogle Scholar
  4. 4.
    Nishida T, Kawai N, Yamaguchi S, Nishida Y. Submucosal tumors: comprehensive guide for the diagnosis of gastrointestinal submucosal tumors. Dig Endosc. 2013;25(5):479–89.CrossRefGoogle Scholar
  5. 5.
    Nakachi A, Miyazato H, Oshiro T, Shimoji H, Shiraishi M, Muto Y. Granular cell tumor of the rectum: a case report and review of the literature. J Gastroenterol. 2000;35:631–4.CrossRefGoogle Scholar
  6. 6.
    Bouillot J-L, Bresler L, Fagniez P, Samama G, Champault G, Parent Y. Laparoscopic resection of benign submucosal gastric tumors. A report of 65 cases. Gastroenterol Clin Biol. 2003;27:272–6.PubMedGoogle Scholar
  7. 7.
    Palanivelu C, Rangarajan M, Parthasarathi R, Senthilkumar R. Laparoscopic resection for benign tumors of the stomach. JSLS. 2007;11(1):81–6.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Palanivelu C. Laparoscopic gastric resection for benign tumors. In: Palanivelu C, editor. Art of laparoscopic surgery. New Delhi: Jaypee Brothers; 2007. p. 495–507.Google Scholar
  9. 9.
    Ponsaing L, Hansen M. Therapeutic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol. 2007;13:3316–22.CrossRefGoogle Scholar
  10. 10.
    Palazzo L, Landi B, Cellier C, Roseau G, Chaussade S, Couturier D, Barbier J. Endosonographic features of esophageal granular cell tumors. Endosocpy. 1997;29:850–3.CrossRefGoogle Scholar
  11. 11.
    De Volgelaere K, Hoorens A, Haentjens P, Delvaux G. Laparoscopic versus open resection of gastrointestinal stromal tumors of the stomach. Surg Endosc. 2013;27:1546–54.CrossRefGoogle Scholar
  12. 12.
    Matthews B, Walsh R, Kercher K, Sing R, Pratt B, Answini G, Heniford B. Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc. 2002;16(5):803–7.CrossRefGoogle Scholar
  13. 13.
    Morinaga N, Sano A, Katayama K, Suzuki K, Kamisaka K, Asao T, Kuwano H. Laparoscopic transgastric tumor-everting resection of the gastric submucosal tumor located near the esophagogastric junction. Surg Laparosc Endosc Percutan Tech. 2004;14(6):344–8.CrossRefGoogle Scholar
  14. 14.
    Yahchouchy E, Etienne J, Fagniez P, Adam R, Fingerhut A. A new “no-touch” technique for the laparoscopic treatment of gastric stromal tumors. Surg Endosc. 2002;16:962–4.CrossRefGoogle Scholar
  15. 15.
    Ahn S, Jung do H, Son S, Lee C, Park do J, Kim H. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer. 2014;17(3):562–70.CrossRefGoogle Scholar
  16. 16.
    Cugar E, Hoyuela C, Rodriguez-Santiago J, Marco C. Laparoscopic ultrasound guidance for laparoscopic resection of benign gastric tumors. J Laparoendosc Adv Surg Tech A. 1999;9(1):63–7.CrossRefGoogle Scholar
  17. 17.
    Wilhelm D, Delius S, Burian M, Schneider A, Frimberger E, Meining A, Feussner H. Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses – analysis of 93 interventions. World J Surg. 2008;32:1021–8.CrossRefGoogle Scholar
  18. 18.
    Choi Y, Oh S. Laparoscopy in the management of gastric submucosal tumors. Surg Endosc. 2000;16(14):741–5.CrossRefGoogle Scholar
  19. 19.
    Watson D, Game P, Devitt P. Laparoscopic resection of benign tumors of the posterior gastric wall. Surg Endosc. 1996;10:540–1.CrossRefGoogle Scholar
  20. 20.
    Zhong-Wei K, Cheng-Zhu Z, Ming-Gen H, Dan-Lei C. Laparoscopic resection of submucosaltumor on posterior wall of gastric fundus. World J Gastroenterol. 2004;10(19):2850–5853.CrossRefGoogle Scholar
  21. 21.
    Tagaya N, Mikami H, Kubota K, Hosoya Y, Nagai H. Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc. 2002;16:177–9.CrossRefGoogle Scholar
  22. 22.
    Na J, Lee S, Noh S. The single incision laparoscopic intragastric wedge resection of gastric submucosal tumor. J Gastric Cancer. 2011;11:225–9.CrossRefGoogle Scholar
  23. 23.
    Sasaki A, Koeda K, Nakajima J, Obuchi T, Baba S, Wakabayashi G. Single-incision laparoscopic gastric resection for submucosal tumors: report of three cases. Surg Today. 2011;41:133–6.CrossRefGoogle Scholar
  24. 24.
    Henckens T, Van de Putte D, Van Renterghem K, Ceelen W, Pattyn P, Van Nieuwenhove Y. Laparoendoscopic single-site gastrectomy for gastric GIST using double-bended instruments. J Laparoendosc Adv Surg Tech A. 2010;20(5):469–71.CrossRefGoogle Scholar
  25. 25.
    Hirano Y, Watanabe T, Uchida T, Yoshida S, Kato H, Hosokawa O. Laparoendoscopic single site partial resection of the stomach for gastrointestinal stromal tumor. Surg Laparosc Endosc Percutan Tech. 2010;20:262–4.CrossRefGoogle Scholar
  26. 26.
    Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Miki A, Ohyama S, Seto Y. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc. 2008;22:1729–35.CrossRefGoogle Scholar
  27. 27.
    Mitsui T, Niimi K, Yamashita H, Goto O, Aikou S, Hatao F, Wada I, Shimizu N, Fujishiro M, Koike K, Seto Y. Non-exposed endoscopic wall-inversion surgery as a novel partial gastrectomy technique. Gastric Cancer. 2014;17:594–9.CrossRefGoogle Scholar
  28. 28.
    Goto O, Mitsui T, Fujishiro M, Wada I, Shimizu N, Seto Y, Korke K. New method of endoscopic full thickness resection: a pilot study of non-exposed endoscopic wall-inversion surgery in an ex vivo porcine model. Gastric Cancer. 2011;14:183–7.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations