MINIMALLY INVASIVE RESECTION OF GASTROESOPHAGEAL JUNCTION GASTROINTESTINAL STROMAL TUMOR (GIST) IN PATIENT WITH A LARGE PARAESOPHAGEAL HERNIA

Classical gastrointestinal anastomoses have been made with sutures and/or metal staples, but have resulted in significant bleeding and leak rates. This video is demonstrating a compression anastomosis using magnets to achieve weight loss and remission of co-morbidities.
A linear magnet was delivered by flexible endoscopic catheter to a point 250 cm proximal to the ileocecal valve, and a second magnet was positioned in the first part of the duodenum; the bowel segments containing the magnets were apposed to initiate gradual incisionless compression. Laparoscopic assistance was used to obtain accurate bowel measurements, obviate tissue interposition, and close mesenteric defects.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the gastrointestinal tract with an annual incidence of 10-15 cases per million. Overall, they account for 0.1%-3.0% of all gastrointestinal tumors. GISTs take time to grow and become clinically expressed, therefore they are commonly an incidental finding. They appear throughout the gastrointestinal tract, however the most common site is the stomach followed by the small intestines, and rarely the rectum or esophagus. Gastroesophageal junction (GEJ) GISTs are extremely rare. We present a case of a unique resection, via DaVinci robot, of a GIST at the GEJ in a patient with type IV paraesophageal hernia.