Localized Excision of Gastrointestinal Stromal Tumor (GIST) After Sleeve Gastrectomy: Highlighting a Sleeve-Preserving Surgical Approach.

Background: Gastrointestinal stromal tumors (GISTs) are relatively rare, accounting for approximately 0.1-3% of all gastrointestinal tumors. Their incidence is higher in individuals aged 50 to 70 years, with an equal gender distribution. Due to their diverse clinical presentations, including upper gastrointestinal (GI) bleeding and gastric discomfort, along with an indolent growth pattern, GISTs can remain undetected for extended periods. This delay in diagnosis can lead to complications. Diagnosis involves upper GI endoscopy, computed tomography (CT) scan, biopsy with histologic grading, and immunohistochemical testing for CD-117 and CD34. The higher incidence of GISTs in patients with obesity underscores the need for preoperative upper GI endoscopic screening.

Methods: A 31-year-old female with a history of sleeve gastrectomy (SG) for obesity (BMI 38 kg/m2) presented 13 months postoperatively with recurrent hematemesis, epigastric fullness, and pain radiating to the back. Despite medical management, including proton pump inhibitors (PPIs), her symptoms persisted. Upper GI endoscopy revealed a polypoidal mass at the gastroesophageal junction (GEJ). Endoscopic ultrasound (EUS) indicated that the lesion originated from the muscularis propria. A contrast-enhanced CT scan confirmed the presence of a polypoid mass without extra-luminal extension, raising suspicion of GIST. The patient underwent laparoscopic resection of the tumor using a sleeve-preserving approach. The tumor was excised with a 1-cm margin of normal tissue, ensuring complete resection with negative margins confirmed by the frozen section. The gastric defect was closed with interrupted sutures, and a 38-Fr gastric tube was placed to maintain luminal patency. The patient had an uneventful recovery, with minimal drain output, and was discharged on postoperative day 3 with continued PPI therapy. Histopathological examination confirmed a low-risk GIST. At 1-year follow-up, the patient remained asymptomatic with no recurrence.

Conclusions: Early detection and sleeve-preserving resection of GISTs in post-sleeve gastrectomy patients ensure effective tumor management while maintaining gastric integrity. This case highlights the importance of preoperative evaluation and long-term follow-up in these patients.