Endoluminal surgery.
The development of laparoscopic surgery has provided minimally invasive surgeons with advanced laparoscopic instrumentation and high definition imaging. The resulting surgical expertise and technology has now been extended to gastric endoluminal surgery. Laboratory and clinical investigations have been initiated for various applications of this new form of surgery. Endoluminal gastric wall excision surgery is the most widely utilized and includes the removal of superficial gastric malignancies, benign gastric wall leiomyomas, and gastric polyps. Clinical experience has increased, and the initial results have been satisfactory. Pancreaticocystogastrostomy can be successfully performed using intraluminal surgery, but gastric wall bleeding and lack of fusion of the stomach to the cyst wall have complicated some cases. There are case reports of foreign body removal and intraluminal surgical procedures for patients with bleeding gastric ulcers. Of primary importance at this stage of development is the surgeon's familiarity with appropriate indications for gastric endoluminal surgery and the access devices currently available. Future considerations include the application of this approach to patients with gastroesophageal reflux disease, occult gastrointestinal bleeding, intractable bleeding from a duodenal ulcer, and multiinstitutional trials of gastric excision procedures.