Efficacy of transgastrostomal endoscopic surgery (TGES) for early gastric cancer

Early gastric cancer is now treated successfully by endoscopic mucosal resection (EMR). This technique, however, is not indicated when the tumoral lesion is located near the esophagogastric (EG)-junction, on the lesser curvature, or in the upper body or near the pylorus ring, and not indicated when the tumor size is greater than 20 mm. For these cases, we have developed what we term, "transgastrostomal endoscopic surgery" (TGES), using a Buess-type scope system. The aim of this study was to evaluate the efficacy of this technique in the treatment of those gastric cancers that could not be treated by EMR. In 4 patients selected for TGES, a Buess-type tube (external diameter: 40 mm) was inserted into the stomach through a temporary gastrostoma, and the whole operation was performed through the Buess-tube, using a video-camera for visualization. Using electrocautery scissors and forceps, complete resection of each lesion was performed, and the wound was closed by sutures. The average operation duration was 195 (130-240) minutes and the average blood loss was 59 (30-100) ml. The average size and margin of the resected specimens were 48 (30-59) and 13 (5-23) mm respectively. TGES is a substitutive, minimally invasive surgery to treat an early gastric cancer for which EMR would be difficult. This technique appeared to be simpler and easier than that of laparoscopic resection especially for a lesion on the posterior side of the stomach.