Objective: To investigate the surgical safety and oncological efficacy of minimally invasive surgery (MIS) for primary gastric gastrointestinal stromal tumors (GISTs) with a maximum diameter of ≤5 cm. Methods: A retrospective cohort study was conducted. The inclusion criteria were as follows: patients undergoing radical local resection via MIS, pathologically confirmed primary gastric GISTs, maximum tumor diameter ≤5 cm, and complete available clinicopathological data, adjuvant therapy information and follow-up records. The exclusion criteria included multiple GISTs, a history of other malignant tumors, and distant metastasis or local invasion detected preoperatively or intraoperatively. Clinical data of 517 patients with gastric GISTs who underwent radical surgery at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2018 to December 2024 were retrospectively collected. All patients were divided into four groups according to surgical approaches: laparoscopic surgery group (Lap group, n=411), robotic surgery group (Robot group, n=9), endoscopic surgery group (Endo group, n=44), and laparoscopic-endoscopic cooperative surgery group (LECS group, n=53). Partial gastrectomy was performed in the Lap, Robot and LECS groups, while endoscopic submucosal dissection was the only surgical method in the Endo group. The Lap group was further subdivided into the favorable anatomical location subgroup (Lap-F group, e.g., anterior wall, greater curvature) and the unfavorable anatomical location subgroup (Lap-C group, e.g., posterior wall, lesser curvature, cardia, pylorus) based on tumor location. The LECS group was divided into the laparoscopy-dominated resection subgroup (LECS-L group) and the endoscopy-dominated resection subgroup (LECS-E group) according to the resection modality. Perioperative outcomes and follow-up data of patients in different groups were observed and analyzed. Results: Among all the patients, 227(43.9%) were male , with a median age of 62.5 (55.0, 68.0) years. There were 105 cases with tumor diameter ≤2.0 cm and 412 cases with 2.1-5.0 cm. According to postoperative pathological risk stratification, 98 cases were very low-risk, 368 low-risk, 36 moderate-risk and 15 high-risk. Baseline data comparison showed no statistically significant differences in gender, age and mitotic count among the Lap, Robot, Endo and LECS groups (all P>0.05), while significant differences were found in tumor growth direction, tumor diameter and pathological risk grade (all P<0.001). No statistically significant baseline differences were observed between the Lap-F and Lap-C groups, nor between the LECS-L and LECS-E groups (all P>0.05). All surgeries were successfully completed in the four groups. R0 resection was achieved in all patients of the Lap, Robot and LECS groups, while the surgical margin could not be evaluated in the Endo group. The average operation time of the four groups was (91.4±40.8) minutes, (104.8±28.8) minutes, (60.2±40.5) minutes and (141.7±19.4) minutes, the numbers of patients with intraoperative blood loss ≤50 ml in each group were 356, 7, 44, and 46, respectively. The median time to resuming liquid diet was 4.0 (3.0,4.0) days, 4.0 (3.0,6.0) days, 3.0 (2.0,3.0) days and 4.0 (4.0,5.0) days, and the median postoperative hospital stay was 6.0 (5.0,7.0) days, 6.0 (5.0,8.5) days, 4.0 (4.0,6.0) days and 7.0 (5.0,8.0) days in the four groups, respectively. Intraoperative complications occurred in 13 cases of the Lap group (all with intraoperative bleeding, blood loss >200 ml), 1 case of intraoperative perforation in the Endo group, 1 case of intraoperative bleeding in the LECS group, and no intraoperative complications in the Robot group. Postoperative complications were observed in 17 cases of the Lap group, including 5 cases of gastroparesis, 10 cases of pulmonary infection, 1 case of pancreatic fistula and 1 case of incision bleeding; no relevant postoperative complications were found in the other three groups. Subgroup analysis revealed that the operation time in the Lap-F group was significantly shorter than that in the Lap-C group [(79.3±39.0) minutes vs. (98.1±40.4) minutes, t=-4.566, P<0.001], with no statistically significant differences in other intraoperative and postoperative outcomes (all P>0.05). No statistically significant differences were found in all intraoperative and postoperative indicators between the LECS-L and LECS-E groups (all P>0.05). The median follow-up duration of all patients was 34 (19, 53) months, and no tumor recurrence, metastasis or death was observed in any patient during the follow-up period. Conclusion: Laparoscopic surgery, robotic laparoscopic surgery, endoscopic surgery and laparoscopic-endoscopic cooperative surgery all yield excellent surgical safety and oncological efficacy in the treatment of gastric GISTs with a maximum diameter of ≤5 cm. Tumor anatomical location has a certain impact on the operation time of laparoscopic surgery, but no significant effect on surgical safety and efficacy. In laparoscopic- endoscopic cooperative surgery, both endoscopy-dominated and laparoscopy-dominated tumor resection achieve comparable surgical safety and therapeutic efficacy.

Postural orthostatic tachycardia syndrome (POTS) is characterized by orthostatic tachycardia with associated symptoms including presyncope, fatigue, dizziness, and gastrointestinal complaints, among others. In addition to cardiovascular and neurologic features, autonomic dysfunction may involve other organ systems. We report a rare case of transient evanescent hyperemia occurring during presyncopal episodes in a patient with POTS, highlighting a potentially underrecognized dermatologic sign of autonomic dysfunction. We present a 19-year-old female with known POTS and a complex medical history including pituitary adenoma (prolactinoma), secondary adrenal insufficiency, gastroparesis, severe malnutrition, and pelvic floor dysfunction, who was admitted for recurrent presyncope, syncope, and collapse. Her presentation was multifactorial. Contributing factors included autonomic instability, cabergoline-related effects, and nutritional compromise. During hospitalization, she developed recurrent episodes of transient, sharply demarcated erythematous patches affecting the face, chest, and upper extremities that coincided with presyncope and resolved spontaneously without intervention. Dermatology evaluation supported a diagnosis of evanescent hyperemia in the setting of autonomic dysfunction associated with POTS. Diagnostic workup included serial laboratory testing, electrocardiography, echocardiography, neuroimaging, and multidisciplinary specialty consultations. Transthoracic echocardiography demonstrated a patent foramen ovale with preserved cardiac function, without evidence of structural heart disease contributing to her symptoms. Management required a multidisciplinary approach, including stress-dose intravenous hydrocortisone for adrenal insufficiency, adjustment of cabergoline due to suspected medication-related bradycardia, continuation of fludrocortisone for volume support, and initiation of nasoduodenal tube feeding for nutritional rehabilitation. This case illustrates a transient cutaneous finding temporally associated with presyncope in a patient with POTS and complex comorbidities. Awareness of such skin changes during symptomatic episodes may provide supportive clinical clues to underlying autonomic dysfunction, particularly in diagnostically challenging presentations.

The mechanical activity of the stomach is mediated by electrical signals. Circular smooth muscle contractions and propagation of peristaltic waves occur during plateau/action potentials and are linked to slow waves generated by interstitial cells of Cajal. These electrical activities form the basis of gastric electrophysiology (EP). Test meals elicit three per minute peristaltic contractions. In contrast, test meals may evoke gastric dysrhythmias in patients with gastroparesis and chronic unexplained nausea. Postprandial gastric myoelectrical activity (GMA) can be recorded with noninvasive electrogastrogram (EGG) and body surface gastric mapping (BSGM).

Scleroderma, meaning "hard skin," refers to a heterogeneous group of disorders in which patients often experience skin thickening and fibrosis. In the systemic form of the disease, systemic sclerosis (SSc), internal organ involvement and vasculopathy are prominent features, with gastrointestinal (GI) involvement especially common and affecting the esophagus in approximately 90% of patients. Symptoms and clinical disorders that reflect GI involvement in the cardinal pathogenic features of scleroderma (ie, vasculopathy, immune-mediated inflammation, and neuropathy) emanate from every segment of the GI tract: dysphagia and gastroesophageal reflux disease from the esophagus; gastroparesis and gastric antral vascular ectasia from the stomach; telangiectasia, pseudo-obstruction, and small intestinal bacterial overgrowth from the small intestine; constipation and colonic dilatation; and fecal incontinence due to thinning of the anal sphincters. Impaired motility is a cardinal feature reflective of atrophy of smooth muscle and scattered areas of fibrosis throughout the GI tract and results in impaired transit, stasis, and luminal dilation leading to complications such as small intestinal bacterial overgrowth, megacolon, and pneumatosis cystoides intestinalis. Symptoms often correlate poorly with the underlying GI pathology and functional impairment in SSc, and associations between GI manifestations, SSc disease features, and autoantibody titers are variable. High-quality SSc-specific evidence regarding the impact of various therapies on GI manifestations remains limited, and management recommendations for most GI manifestations are largely derived from experience in non-SSc patients. In caring for the patient with SSc with GI problems, a gastroenterologist should be aware of the particularities of clinical presentation and natural history of GI disease in this patient population, maintain diagnostic vigilance, and tailor their therapeutic approach mindful of the SSc disease process.