Minimally invasive approaches to benign gastric tumors are a preferred surgical treatment option for some submucosal lesions located at the gastroesophageal junction (GEJ). As they may either be benign or malignant, pre-operative evaluation identifies benign lesions amenable to local resection with tumor-free margins. Operative technique is dependent on tumor location.

A 69-year old male with chronic gastroesophageal reflux disease, unable to tolerate proton pump inhibitors, had contrast imaging and endoscopy revealing a small hiatus hernia and a 2.0 cm mass at the GEJ. Endoscopic ultrasound and computed tomography confirmed limitation to the submucosa, with intact muscularis propria and absence of additional lesions in the liver or retroperitoneum. Intraoperatively, the GEJ was mobilized and the GEJ tumor was apparent. Following anterior gastrotomy, the tumor was elevated and a linear stapler placed with endoscopic control.

Intraoperative endoscopic control allowed for laparoscopic transgastric resection of the GEJ mass without compromising the esophageal lumen. Repair of the patulous hiatus and creation of a floppy fundoplication were also performed. Pathologic diagnosis was a cavernous hemangioma with clear surgical margins.

Intra-operative endoscopic assistance allows for safe laparoscopic resection of lesions at the GEJ.