The role of endosonography in a rare submucosal tumor's laparoscopic surgery

The endosonography is one of the most important diagnostic procedures in cases of submucosal tumors. Moreover the surgical concept cuold be depend on the endosonography localisation. Tumors unable to endoscopic resection would be operated on depend on u-T, u-N staging. On our departement the endosonography routinelly use from 2007 to help definitive organ saving laparoscopic surgery on gastrointestinal tract. Case report: 75 y.o. woman admitted to gastroenterology for abdominal complains, and ananemia. We found an antral polyp hence results gastric outlet obstruction due to temporally sliding movement throught pylorus to duodenum. Endosonography verified submucosal origin of the polyp,. Laparoscopic resection performed with simultaneously intraopertive gastroscopy. On course of operation the polyp was taken and stabilised with gastroscopy snare and puled out completely with gastroscope after laparscopic resection of gastric wall. The closing of gastric resection was visually controlled sith gastroscope. The histology result of surgical specimen was inflamatoric fibroid polyp (IFP) or Vanek's tumor, with intact resection surface. That differed from endoscopic biopsy wich resulted duodenal gastric heterotopy. Conclusion: The IFP relativelly rare polyp of the uper gastrointestinal tract and often appeares in the distal stomach region, located in the second and/or third sonographic layer of the gastric wall without involvement of the fourth layer.. In the differential diagnosis, it is important to distinguish namely eosinophilic gastroenteritis, gastrointestinal stromal tumor, inflammatory pseudotumor, hemangioendothelioma, and hemangiopericytoma. Usually the surgical procedure is gastrectomy. In our case the endosonography diagnosing of sumucosal tumor allowed and the combinated method of laparoscopic organ saving surgery with intraoperative gastroscopy. This promising procedure could result better outcome of healing and shorter hospitalisation in certain group of patients.