- Indocyanine Green Fluorescence-Guided Enucleation via the Serosal Approach for Benign Subepithelial Tumors of the Gastroesophageal Junction
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Ji-Hyeon Park, Sojung Kim, Ho Seok Seo, Kyo Young Song, Han Hong Lee
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Received December 1, 2025 Accepted December 8, 2025 Published online December 11, 2025
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DOI: https://doi.org/10.69474/jsie.2025.00283
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 Abstract
- Subepithelial tumors (SETs) located at the gastroesophageal (GE) junction remain technically challenging in minimally invasive surgery because the convergence of the esophageal sphincter, diaphragmatic hiatus, and gastric fundus creates a confined operative field. When a tumor is fully embedded within the muscular layer, its capsular margin is often indistinguishable from the serosal surface, making precise enucleation technically demanding. To address this limitation, we adopted a fluorescence-guided technique that enables accurate intraoperative localization of the tumor through indocyanine green (ICG) injection. After induction of anesthesia, approximately 0.1–0.2 mL (0.05–0.1 mg) of ICG diluted in normal saline is injected endoscopically into the submucosal plane at the tumor site for benign SETs. During surgery, near-infrared visualization provides a distinct fluorescent margin that guides safe serosal incision and enucleation while preserving the mucosa and the anatomy of the GE junction. This technique is particularly useful for benign, well-encapsulated lesions such as leiomyoma or ectopic pancreas, where clear dissection planes can be preserved. However, it should not be used for lesions with any suspicion of gastrointestinal stromal tumor or other malignant potential, because capsular or intratumoral injection may pose a theoretical risk of tumor cell dissemination. Careful peritumoral submucosal injection that avoids capsular disruption may be cautiously considered. In selected benign tumors, ICG-guided serosal enucleation provides clear localization, facilitates complete resection, and minimizes both functional and structural complications at the GE junction.
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