LECS in Istanbul: when endoscopy and laparoscopy work together

The short version

• LECS combines an internal endoscopic view with laparoscopic surgery.

• Suitability depends on the lesion, its location and the expertise of the team.

• Surveillance, endoscopic treatment alone or another operation may be more appropriate.

What does the combined approach do?

An endoscope helps identify the lesion from inside the stomach. Laparoscopic instruments work from the abdominal side. The team coordinates removal and closure, aiming to avoid unnecessary removal of surrounding stomach tissue.

LECS is therefore not an incision-free procedure or simply another name for ESD. An early clinical study describes its use for selected gastric submucosal tumours, with endoscopy, EUS and CT forming part of assessment. Its findings cannot establish what will happen in an individual patient. Original LECS clinical study

Sources: [3]

Does a bulge under the lining always need surgery?

No. Endoscopic ultrasound can help assess size, location and the layer of origin, but does not identify every lesion with certainty. Tissue sampling may be needed.

ESGE describes both surveillance and removal pathways. For some small, confirmed gastric GISTs, removal is an alternative to surveillance, with the choice discussed by a multidisciplinary team. Size alone does not select LECS. ESGE guideline

Ask: “What do we know about this growth, and what information is still missing?”

Sources: [1]

Which alternatives should be considered?

Management depends on symptoms, tissue diagnosis and malignant potential as well as size. AGA advice includes considering resection for lesions that bleed, ulcerate or cause symptoms. That is not a recommendation for one particular removal technique. AGA clinical practice update

The consultation should compare surveillance, an appropriate endoscopic technique, conventional laparoscopic resection and any more extensive surgery that the diagnosis may require. Ask why the proposed option is preferable for your specific anatomy, rather than assuming that the smallest incision is always the safest choice.

Sources: [2]

Is every LECS procedure the same?

No. Classical LECS opens the stomach wall during part of the procedure. Other approaches have been developed to avoid exposing the abdominal cavity to stomach contents. Concerns include contamination and, in certain tumours, tumour-cell dissemination.

A 2024 multicentre study reported outcomes from selected Japanese institutions. It was retrospective—not a randomised proof that LECS is best for every lesion. It also recorded complications and reoperations. These are not Unimed outcome data. Multicentre LECS study

Sources: [4]

What risks and limitations should I discuss?

Ask about bleeding, leakage from the closure, infection, changes affecting food passage or intake, and the possibility of additional treatment. The multicentre study documents postoperative bleeding, leakage and later poor oral intake among the issues assessed. Successful removal does not automatically mean that no follow-up is needed. Multicentre LECS study

Request an individual discussion of anaesthesia, existing illnesses and the backup plan if the intended approach cannot be completed. No success percentage or fixed recovery time in an overseas package can replace that discussion.

Sources: [4]

What should follow-up include?

Ask who will explain the final pathology, whether the margins are clear and whether further treatment is needed. ESGE bases follow-up on the type of lesion and completeness of removal; there is no single schedule suitable for every diagnosis. ESGE guideline

Before discharge, request written instructions covering eating, activity, medicines and urgent symptoms, along with a named contact and a plan for care at home. Severe or worsening abdominal pain, fever, repeated vomiting, bleeding or difficulty breathing warrants urgent medical assessment rather than waiting for a routine message.

Sources: [1]

How can I prepare for an Istanbul assessment?

Bring your questions—not an assumption that LECS is already confirmed.

• Which endoscopy images, EUS findings, scans and pathology reports are needed?

• Will both an endoscopist and surgeon review the case?

• Which hospital and team would provide treatment, if appropriate?

• Who manages complications and follow-up after returning home?

Ask for a secure route to share records before sending medical documents. Travel dates, hospital stay and fitness to fly should follow the treating team's assessment.

Prof. Dr. Barış Yılmaz's profile lists LECS among his clinical interests. This article does not imply his review, a confirmed appointment or guaranteed procedure availability.

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