Using endoscopy to minimize the extent of resection in the management of giant GISTs of the stomach

INTRODUCTION: The stomach is the most common site for GISTs. Wide local resection to achieve negative margins is the standard of care. Giants GISTs requiring extensive resection are usually managed with neo-adjuvant therapy followed by partial or total gastrectomy. PRESENTATION OF CASE: We present a case report of a giant GIST on the lesser curvature of the stomach. Neo-adjuvant therapy was administered. Intra-operative endoscopy was used to reduce the extent of gastric resection. DISCUSSION: Simultaneous intra-operative endoscopy demonstrated a 2 mm fistula on the lesser curvature of the stomach. A stapler was used to encompass the mass and the fistulous opening. A frozen-section showed clear margins and the endoscope was used to perform an air-leak test. The patient recovered without complications. CONCLUSION: Intra-operative endoscopy can reduce the extent of gastric resection for large GISTs while maintaining the oncologic principles of negative margins and minimal tissue handling.