Clin Endosc.  2016 May;49(3):232-234. 10.5946/ce.2016.052.

Long-Term Outcomes after Endoscopic Treatment of Gastric Gastrointestinal Stromal Tumor

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. gi7pjj@korea.ac.kr

Abstract

Endoscopic resection of gastric subepithelial tumors (SETs) has several advantages over biopsy techniques, such as superior diagnostic yield and definite diagnosis. Removal of gastric SETs and histopathologic confirmation should be considered whenever gastric SETs are highly suspected to have malignant potential such as gastrointestinal stromal tumor (GIST) or neuroendocrine tumor. According to our clinical experience, we suggest that endoscopic resection of gastric SETs is feasible for GISTs less than 3.0 cm without positive endoscopic ultrasonography findings or for hypoechoic SETs less than 3.0 cm. However, serious complications such as macroperforation may occur during endoscopic resection, and this procedure is highly dependent on endoscopists' skills. We recently reported the long-term clinical outcomes of endoscopic resection of gastric GIST, which showed a relatively low recurrence rate (2.2%) during long-term follow-up (46.0±28.5 months) despite the low R0 resection rate (25.0%). We suggest that endoscopic surveillance might be possible without additional surgical resection in completely resected GISTs without residual tumor confirmed to be lower risk, even if they show an R1 resection margin.

Keyword

Subepithelial tumor; Gastrointestinal stromal tumors; Endoscopy

MeSH Terms

Biopsy
Diagnosis
Endoscopy
Endosonography
Follow-Up Studies
Gastrointestinal Stromal Tumors*
Neoplasm, Residual
Neuroendocrine Tumors
Recurrence

Reference

1. Hedenbro JL, Ekelund M, Wetterberg P. Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc. 1991; 5:20–23.
2. Jeong ID, Jung SW, Bang SJ, Shin JW, Park NH, Kim do H. Endoscopic enucleation for gastric subepithelial tumors originating in the muscularis propria layer. Surg Endosc. 2011; 25:468–474.
Article
3. Hwang JH, Rulyak SD, Kimmey MB; American Gastroenterological Association Institute. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology. 2006; 130:2217–2228.
Article
4. von Mehren M, Randall RL, Benjamin RS, et al. Gastrointestinal stromal tumors, version 2.2014. J Natl Compr Canc Netw. 2014; 12:853–862.
Article
5. Kang YK, Kim KM, Sohn T, et al. Clinical practice guideline for accurate diagnosis and effective treatment of gastrointestinal stromal tumor in Korea. J Korean Med Sci. 2010; 25:1543–1552.
Article
6. Li L, Wang F, Wu B, Wang Q, Wang C, Liu J. Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria. Exp Ther Med. 2013; 6:391–395.
Article
7. Chun SY, Kim KO, Park DS, et al. Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: a preliminary analysis of appropriate indications. Surg Endosc. 2013; 27:3271–3279.
Article
8. Lee IL, Lin PY, Tung SY, Shen CH, Wei KL, Wu CS. Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy. 2006; 38:1024–1028.
Article
9. Park YS, Park SW, Kim TI, et al. Endoscopic enucleation of upper-GI submucosal tumors by using an insulated-tip electrosurgical knife. Gastrointest Endosc. 2004; 59:409–415.
Article
10. Goessl C, Hempfling W, Hoppe B, Stolte M, Frank N. Endoscopic enucleation of small gastrointestinal stromal tumors from the stomach. Endoscopy. 2007; 39 Suppl 1:E308.
Article
11. Sun S, Jin Y, Chang G, Wang C, Li X, Wang Z. Endoscopic band ligation without electrosurgery: a new technique for excision of small upper-GI leiomyoma. Gastrointest Endosc. 2004; 60:218–222.
Article
12. Hoteya S, Iizuka T, Kikuchi D, Yahagi N. Endoscopic submucosal dissection for gastric submucosal tumor, endoscopic sub-tumoral dissection. Dig Endosc. 2009; 21:266–269.
Article
13. Białek A, Wiechowska-Kozłowska A, Pertkiewicz J, et al. Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc. 2012; 75:276–286.
14. Catalano F, Rodella L, Lombardo F, et al. Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study. Gastric Cancer. 2013; 16:563–570.
Article
15. Kobara H, Mori H, Rafiq K, et al. Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa. Mol Clin Oncol. 2013; 1:1002–1008.
Article
16. He Z, Sun C, Wang J, et al. Efficacy and safety of endoscopic submucosal dissection in treating gastric subepithelial tumors originating in the muscularis propria layer: a single-center study of 144 cases. Scand J Gastroenterol. 2013; 48:1466–1473.
Article
17. Zhang S, Chao GQ, Li M, Ni GB, Lv B. Endoscopic submucosal dissection for treatment of gastric submucosal tumors originating from the muscularis propria layer. Dig Dis Sci. 2013; 58:1710–1716.
Article
18. Joo MK, Park JJ, Kim H, et al. Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract. Gastrointest Endosc. 2016; 83:318–326.
Article
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