Application of Intragastric Single-Incision Laparoscopy Surgery in the Management of Gastroesophageal Junction Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumors (GISTs) at the gastroesophageal junction (GEJ) pose significant surgical challenges due to their proximity to critical structures. Traditional laparoscopic techniques can lead to excessive tissue removal and complications such as gastroesophageal reflux or pyloric stenosis, while transgastric approaches increase the risks of tumor seeding and intraperitoneal infections. Intragastric single-incision laparoscopic surgery (I-SILS) offers a novel solution by combining intragastric visualization of the tumor and laparoscopic precision with single-port access, allowing for direct tumor visualization and resection while preserving GEJ function. This article presents a 43-year-old male patient with an endophytic GEJ GIST (46.8 mm × 33.9 mm × 30.0 mm in size), successfully treated using I-SILS, as a representative example. The procedure was completed in 42 min with minimal blood loss. The mucosal and submucosal defect was repaired using continuous sutures along the long axis of the stomach to maximize function preservation, and the patient experienced an uneventful recovery with no postoperative complications. The patient was reviewed one year after surgery, and no stenosis or reflux was observed. This approach provides several advantages, including improved tumor visualization, reduced risk of tumor seeding, and preservation of normal gastric and esophageal function. However, this technique is not suitable for all GISTs, particularly those larger than 5 cm. Patient selection and preoperative assessment are crucial. Further research, including large-scale, randomized controlled trials -- is needed to confirm the indications, safety, and effectiveness of I-SILS for GEJ GISTs.