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Park N, Lim DR, Kuk JC, Shin EJ. Comparing clinical characteristics and surgical outcomes of gastric and small bowel GIST: A single center experiences. Asian J Surg 2023; 46:4235-4239. [PMID: 36621428 DOI: 10.1016/j.asjsur.2022.12.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Gastrointestinal stromal tumor (GIST) is a rare kind of neoplasm at the gastrointestinal tract. There are few studies regarding the comparison of gastric and small bowel GIST in Korea. We aimed to analyze clinical characteristics and outcomes between gastric and small bowel GIST after curative resection. METHODS Between May 2005 and Dec 2017, 165 patients who underwent curative resection for gastric GIST (n = 115) and small bowel GIST (n = 50) were retrieved from a retrospective database. They were compared with respect to clinical, pathologic and oncological outcomes. RESULTS The mean age at surgery in both two group was similar (58.8 vs. 58.6, p = 0.772). The rate of emergency admission and surgery was higher in small bowel GIST group (p < 0.005). The mitotic rate and risk category were not significantly different between the two groups. However, the T stage was higher in small bowel GIST compared to the T stage of gastric GIST (22.6% vs. 44.0%, p = 0.025). During the follow-up, 5-year disease free survival rate was worse in small bowel GIST (82.0%) compared gastric GIST (93.7%) (p = 0.032). 5-year survival rate was not significantly different between the two groups (100.0% vs. 97.7%, p = 0.578). The T stage, mitotic count, and risk category were independent prognostic factors for disease free survival of Gastric and small bowel GIST in Cox multivariate analysis. CONCLUSION Small bowel GIST has more advanced T stage and higher rate of emergency surgery. Disease free survival rate was worse in small bowel GIST. Larger scaled prospective study of small bowel GIST is needed.
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Affiliation(s)
- Nahyeon Park
- Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Dae Ro Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
| | - Jung Cheol Kuk
- Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Eung Jin Shin
- Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
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Guo HM, Sun Y, Cai S, Miao F, Zheng Y, Yu Y, Zhao ZF, Liu L. A novel technique for endoscope progression in gastroscopy resection: forward-return way for dissection of stromal tumor in the muscularis propria of the gastric fundus. Front Oncol 2023; 13:1077201. [PMID: 37274232 PMCID: PMC10233095 DOI: 10.3389/fonc.2023.1077201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background The fundus of the stomach is a challenging region for endoscopic resection of gastrointestinal stromal tumors (GISTs), especially in the anterior wall of the fornix at the side of the greater curvature. This study aimed to introduce the Forward-Return Way (FRW) technique in gastric fundus operations and provide evidence of its advantages. The FRW technique allows the gastroscope to access the stomach fornix without entering the gastric antrum after passing through the gastric cardia. Using FRW, the gastroscope body makes a forward return along the wall of the posterior wall of the upper gastric body and the wall of the greater curvature. Methods The clinical data of patients with stromal tumors in muscularis propria at the gastric fundus (STMF) at the Fourth Hospital of China Medical University between May 2020- March 2021 were reviewed. The novel FRW technique was used in the procedures, and the beneficial effects, suitability, applicable lesion site, and success rates of FRW were analyzed. Results A total of 10 cases were reviewed, and the FRW technique was successfully performed in 7 cases (70%). The gastroscope's tip reached the area just below the gastric cardia, allowing endoscopists to successfully access all angles and sites of the stomach's fundus in all seven patients. The lesion was easily accessed, and the gastroscope was stable with good left-right and forward-backwards movements. Conclusion The FRW technique significantly facilitates the resection of the GISTs by aligning the endoscopy body movement direction with the observation direction. Gastrointestinal Stromal Tumor; forward-return of gastroscopy along the gastric body wall; muscularis propria; gastric fundus.
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3
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Zhou Y, Yu K. Th1, Th2, and Th17 cells and their corresponding cytokines are associated with anxiety, depression, and cognitive impairment in elderly gastric cancer patients. Front Surg 2022; 9:996680. [PMID: 36386524 PMCID: PMC9640774 DOI: 10.3389/fsurg.2022.996680] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Objective T helper (Th) cells modulate the stress response, oxidative stress, and neuroinflammation to mediate anxiety, depression, and cognitive impairment. This study intended to explore the association between Th cells and anxiety, depression, and cognitive impairment in elderly gastric cancer patients. Methods Totally, 176 elderly gastric cancer patients were enrolled in this study. Peripheral blood samples were collected. Th1, Th2, and Th17 cells were detected by flow cytometry; their corresponding cytokines were examined by ELISA. The Hospital Anxiety and Depression Scale (HADS) and Mini-Mental State Examination (MMSE) were assessed. Results In total, 42.0%, 33.0%, and 19.9% of elderly gastric cancer patients presented anxiety, depression, and cognitive impairment, respectively. Th1 (P = 0.016), Th17 (P = 0.009), and IL-17A (P = 0.001) were positively associated with the HADS-A score. Th17 (P = 0.003) and IL-17A (P = 0.009) levels were increased in patients with anxiety compared with those without anxiety. Concurrently, a positive association was observed for Th1 (P = 0.027), Th17 (P = 0.014), and IFN-γ (P = 0.049) with the HADS-D score. Th1 (P = 0.017) and Th17 (P = 0.049) levels were increased in patients with depression than in those without depression. Moreover, Th1 (P = 0.003), Th17 (P < 0.001), IFN-γ (P = 0.014), and IL-17A (P < 0.001) were inversely related to MMSE scores, but only Th17 (P < 0.001) and IL-17A (P < 0.001) were increased in patients with cognitive impairment compared with those without cognitive impairment. Conclusion Th1 and Th17 cells reflect anxiety, depression, and cognitive impairment risk to a certain extent in elderly gastric cancer patients, implying their involvement in the pathology of the abovementioned psychological and cognitive issues. However, further validation is needed.
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Affiliation(s)
- Yanxia Zhou
- Nursing Department, Chenzhou First People’s Hospital of Hunan Province, Chenzhou, China
| | - Ke Yu
- Operation Room, Changsha Hospital for Maternal / Child Health Care Affiliated to Hunan Normal University, Changsha, China
- Correspondence: Ke Yu
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Yu Z, Tu H, Liang C, Qiu S, Dong X, Zhang Y, Ma C, Li P. Therapeutic Effects of 4 Surgical Approaches for Small Gastrointestinal Stromal Tumors: A Network Meta-analysis. Surg Laparosc Endosc Percutan Tech 2022; 32:606-615. [PMID: 35960698 DOI: 10.1097/sle.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
This study aims to systematically evaluate the efficacy of endoscopic resection (ER), laparoscopic resection (LR), laparoscopic endoscopic cooperative surgery (LECS), and open surgery (OpS) for gastrointestinal stromal tumors with small diameters (≤5 cm). Relevant studies were collected through Pubmed, Cochrane Library, and Embase databases. Operative time, hospital stays, time to liquid diet, intraoperative bleeding, and complications were used as outcome indicators for meta-analysis. Twenty-four retrospective cohort studies with 2406 participants were analyzed. LR and OpS groups had longer operating time than the ER group. ER, LECS, and LR groups had decreased lengths of hospital stay than the OpS group. Moreover, patients in LR and LECS groups had fewer complications than those in the OpS group. Endoscopic operation for small gastrointestinal stromal tumors contributes to shortened lengths of surgery and hospital stay. This reduces intraoperative blood loss and promotes gastroenteric functional recovery without increasing the risk of complications or tumor recurrence.
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Affiliation(s)
- Zhiyuan Yu
- School of Medicine, Nankai University, Tianjin
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital
| | - Huaiyu Tu
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital
| | - Chen Liang
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, First Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shuzhong Qiu
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital
| | - Xiaoyu Dong
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital
| | - Yonghui Zhang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital
| | - Chao Ma
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital
| | - Peiyu Li
- School of Medicine, Nankai University, Tianjin
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital
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5
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Cimpean S, Francois F, Muresan MS. Laparoscopic subtotal gastrectomy in case of large subcardial GISTs. J Surg Case Rep 2022; 2022:rjac396. [PMID: 36051006 PMCID: PMC9427202 DOI: 10.1093/jscr/rjac396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/11/2022] [Indexed: 11/12/2022] Open
Abstract
The gastro-intestinal stromal tumours (GISTs) are rare mesenchymal tumours that occur mostly in the stomach. The treatment is usually a limited resection, which is performed by an endoscopy or by a surgical approach. In case of metastasis of the disease proven found during the assessment, the treatment is usually limited to chemotherapy without a radical cure. We report a case of a large (9 cm) subcardial GIST that we treated by laparoscopic subtotal gastrectomy due to the size and the location of the tumour. The laparoscopic resection is shown to be superior in perioperative outcomes compared to open surgery even for large lesions. In unfavourable locations such as in cardia lesions, transgastric, partial or extended gastric resections must be evaluated to avoid functional sequelae and post-operative morbidity.
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Affiliation(s)
- Sorin Cimpean
- General Surgery, South Iris Hospitals , Brussels , Belgium
| | - Flamand Francois
- General Surgery, Clinique Notre Dame de Grace , Charleroi , Belgium
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Jeong YJ, Hwang HS, Park YE, Nam KH, Oh SJ. A Huge Malignant Gastric Gastrointestinal Stromal Tumor in a Young Patient. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 79:177-181. [PMID: 35473776 DOI: 10.4166/kjg.2022.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/03/2022]
Abstract
Malignant gastrointestinal stromal tumors (GISTs) are rare neoplasms originating from the gastrointestinal tract that rarely occur in patients below 40 years of age. To our knowledge, there have been no previous reports of satellite and metastatic nodules in GIST. We present a case of a young patient with a huge malignant gastric GIST accompanied by spontaneous bleeding and satellite and metastatic nodules, successfully treated surgically, without preoperative chemotherapy administration. A 28-year-old man was admitted to Haeundae Paik Hospital with melena. A huge bulging gastric mass with ulceration and bleeding was observed on endoscopy. A subepithelial lesion on the stomach body, abutting the pancreatic body and tail, with regional lymph node enlargement was confirmed by EUS and CT. Radical total gastrectomy was performed, the invasion surrounding the pancreatic tail and spleen were surgically dissected, and enlarged lymph nodes around the celiac trunk and the common hepatic artery were removed. The pathology results showed a malignant GIST with two satellite nodules and a metastatic tumor nodule at the left paracardial lymph node site. After complete resection of the malignant GIST, adjuvant chemotherapy with imatinib was initiated. Follow-up CT and endoscopy performed 6 months after surgery confirmed no recurrence of the disease.
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Affiliation(s)
- Yun Jin Jeong
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Seung Hwang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Eun Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyung Han Nam
- Department of Pathology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Jin Oh
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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7
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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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8
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Ban T, Kubota Y, Nakamura M, Ando T, Sasoh S, Ichikawa H, Takahama T, Urano M, Joh T. Unusual Gastrointestinal Hemorrhaging Mimicking a Rupture of Solitary Gastric Varices Due to a Gastric Gastrointestinal Stromal Tumor with Exogenous Growth. Intern Med 2022; 61:653-656. [PMID: 34433723 PMCID: PMC8943378 DOI: 10.2169/internalmedicine.8003-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Gastric gastrointestinal stromal tumors can lead to upper gastrointestinal hemorrhaging, which is usually caused by dimpling or ulceration on the tumor surface. While rare, pedunculated gastric gastrointestinal stromal tumors outside the stomach can present as a huge mass with delayed complaints. We herein report an unusual hemorrhaging mimicking a rupture of solitary gastric varices due to a pedunculated gastric gastrointestinal stromal tumor. In this case, contrast-enhanced computed tomography (CECT) was essential for tumor detection. An endoscopic investigation revealed dilated, aberrant veins and arteries in the submucosa of this tumor, recognized as solitary gastric varices.
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Affiliation(s)
- Tesshin Ban
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
| | - Makoto Nakamura
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
| | - Tomoaki Ando
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
| | - Shun Sasoh
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
| | - Hiroshi Ichikawa
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
| | - Takuya Takahama
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
| | - Makoto Urano
- Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Japan
| | - Takashi Joh
- Department of Gastroenterology and Hepatology, Gamagori Municipal Hospital, Japan
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Fan X, Han H, Sun Z, Zhang L, Chen G, Mzee SAS, Yang H, Chen J. Prognostic Value of Bleeding in Gastrointestinal Stromal Tumors: A Meta-Analysis. Technol Cancer Res Treat 2021; 20:15330338211034259. [PMID: 34323156 PMCID: PMC8330451 DOI: 10.1177/15330338211034259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Gastrointestinal bleeding is the most common clinical manifestation of gastrointestinal stromal tumor. It is of great significance to the prognosis of patients. But the results are controversial. The purpose of this study was to evaluate the relationship between gastrointestinal bleeding and clinical prognosis in patients with GIST. Methods: A systematic literature search was performed in Pumbed, Cochrane Library, EMBASE, ClinicalTrials.gov, CNKI, VIP and wanfang databases with the pattern of unlimited languages. 12 studies with 2781 individuals were included in the final analysis. The overall survival (OS), recurrence-free survival/disease-free survival (RFS/DFS) and related factors affecting bleeding in patients with gastrointestinal stromal tumor (GIST) were extracted. Hazard ratio (HR) and 95% confidence interval (CI) were used for in the meta-analysis. Results: A total of 12 articles were included in the study, including 2781 patients with GIST, including 845 patients with gastrointestinal bleeding. The OS of GIST patients with gastrointestinal bleeding was significantly worse (HR = 2.54, 95% CI = 1.13-5.73, P = 0.025). But there was no significant difference in RFS between gastrointestinal bleeding patients and non-bleeding patients (HR = 1.35, 95% CI = 0.70-2.61, P = 0.371). Further analysis of the related factors of GI bleeding in GIST patients was observed, besides the aging factor (HR = 1.02, 95% CI = 0.69-1.50, P = 0.929), Small intestinal stromal tumor (HR = 0.56, 95% CI = 0.41-0.76, P < 0.001), tumor diameter ≥ 5 cm (HR = 2.09, 95% CI = 1.20-3.63, P = 0.009), Mitotic index ≥ 5/50 HPF (HR = 1.66, 95% CI = 1.11-2.49, P = 0.014) and tumor rupture (HR = 2.04, 95% CI = 1.0-3.82, P = 0.026) all increased the risk of GI bleeding in patients with GIST. Conclusions: The OS of GIST patients with GI bleeding was worse than non-GI bleeding, but had no significant effect on RFS. Nevertheless the aging factor, the location of GIST in the small intestine, tumor diameter ≥ 5 cm, Mitotic index ≥ 5/50 HPF and tumor rupture all increased the risk of GI bleeding in patients with GIST.
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Affiliation(s)
- Xin Fan
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - He Han
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhiyu Sun
- Medical College, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Liwen Zhang
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Gong Chen
- Medical College, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Said Abdulrahman Salim Mzee
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hanqing Yang
- 567917Wujin People's Hospital, Changzhou, Jiangsu, China
| | - Jixiang Chen
- Department of Gastrointestinal Surgery, Affiliated 191612Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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10
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Wang S, Zhang K, Xiao M. Endoscopic obturation with tissue adhesive for bleeding gastric stromal tumor: a case report. J Int Med Res 2021; 49:300060521991355. [PMID: 33535827 PMCID: PMC7869159 DOI: 10.1177/0300060521991355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary endoscopic hemostasis for bleeding gastrointestinal stromal tumor (GIST) is rarely reported. Herein, we report the case of a patient with a bleeding GIST that was treated with endoscopic obturation with tissue adhesive. A 46-year-old man presented with hematemesis and tarry stool for 1 day. Upper GI endoscopy revealed a bleeding submucosal tumor at the stomach fundus and an exposed pulsatile vessel was seen at the defect. Endoscopic obturation with tissue adhesive was performed to treat the defect and the bleeding was successfully stopped. No recurrence of bleeding was observed through a gastric tube, and 6 days after endoscopic obturation, the patient underwent laparoscopic partial gastrectomy. Endoscopic obturation with tissue adhesive is a feasible and effective method to treat bleeding GIST.
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Affiliation(s)
- Song Wang
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, 12652University of Science and Technology of China, Hefei, Anhui Province, China
| | - Kaiguang Zhang
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, 12652University of Science and Technology of China, Hefei, Anhui Province, China
| | - Mei Xiao
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, 12652University of Science and Technology of China, Hefei, Anhui Province, China
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11
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Huang Y, Shih K, Yang C, Chen Y, Yen H. Bleeding gastrointestinal stromal tumor mimicking ectopic variceal bleeding and treated successfully with endoscopic sclerotherapy. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yen‐Pin Huang
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Kai‐Lun Shih
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Chia‐Wei Yang
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Yang‐Yuan Chen
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Hsu‐Heng Yen
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
- School of Medicine, Chung Shan Medical University Taichung Taiwan
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12
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Aguayo WG, Moyon FX, Molina GA, Moyon MA, Rivadeneira DJ, Rojas CL, Cárdenas BA, Cobo MM, Romero AK. A bleeding GIST in pandemic times, a cooperative approach to a delayed complication, a case report. Int J Surg Case Rep 2020; 77:880-884. [PMID: 33395916 PMCID: PMC7732962 DOI: 10.1016/j.ijscr.2020.11.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Upper gastrointestinal bleeding is one of the major manifestations of the stomach's gastrointestinal stromal tumors; when gastric GISTs bleed, they are associated with a poor prognosis and must be treated promptly to avoid dangerous complications. A worrisome side effect of the Covid-19 pandemic is the delay in surgical treatment for seriously ill patients, a rise in surgical complications due to delayed care, lack of access to the healthcare system, and patients' hesitancy to seek care due to fear of the virus. In Ecuador, where limitations were present even in the absence of a pandemic, we are yet to fully know the full extent of the damage this pandemic has caused to ourselves and our patients. PRESENTATION OF CASE We present the case of a 51-year-old female; she presented with upper gastrointestinal bleeding, and a gastric GIST was diagnosed. Due to the size and the symptoms, surgery was planned. Nonetheless, as Ecuador was hit hard by the Covid-19 pandemic to cope with the respiratory patients, surgeries were delayed or canceled. Our patient surgery was delayed for five months until she presented with severe gastrointestinal bleeding that required urgent action and care. Thankfully, she completely recovered. DISCUSSION AND CONCLUSIONS This case is an example of the many complications we expect due to the pandemic; delay in treatment leads to troublesome complications. In these emergencies, time is of the essence, and surgical services must rise to the challenge; in a particular way, this case also proves that if there are the necessary tools to enhance the patient's recovery, we should hesitate to use them. Complete resection of the gastric GIST in a prompt matter must be done to avoid these potentially deadly complications.
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Affiliation(s)
| | | | - Gabriel A Molina
- Iess Quito-Sur & Universidad San Francisco de Quito (USFQ), Quito, Ecuador.
| | | | | | | | | | - Maria M Cobo
- Universidad San Francisco de Quito (USFQ), Quito, Ecuador.
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Pih GY, Ahn JY, Choi JY, Na HK, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Clinical outcomes of tumor bleeding in duodenal gastrointestinal stromal tumors: a 20-year single-center experience. Surg Endosc 2020; 35:1190-1201. [PMID: 32170563 DOI: 10.1007/s00464-020-07486-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumors (GISTs) are rare, and reports on duodenal GIST bleeding are few. We analyzed the risk factors and clinical outcomes of hemorrhagic duodenal GISTs and compared them with those of gastric GISTs. METHODS Primary duodenal GISTs surgically diagnosed between January 1998 and December 2017 were retrospectively reviewed. Furthermore, patients with duodenal GIST were compared with those with primary gastric GIST histopathologically diagnosed between January 1998 and May 2015 using previously published data. RESULTS Of the 170 total patients with duodenal GISTs, 48 (28.2%) exhibited tumor bleeding. Endoscopic intervention, embolization, and non-interventional conservative treatment were performed for initial hemostasis in 17, 1, and 30 patients, respectively. The 5-year survival rate was 81.9% in the bleeding group and 89.4% in the non-bleeding group (P = 0.495). Multivariate analysis showed that p53 positivity was a significant risk factor for duodenal GIST bleeding (hazard ratio [HR] 2.781, P = 0.012), and age ≥ 60 years (HR 3.163, P = 0.027), a large maximum diameter (comparing four groups: < 2, 2-5, 5-10, and ≥ 10 cm), and mitotic count ≥ 5/high-power field (HPF) (HR 3.265, P = 0.032) were risk factors for overall survival. The incidence of bleeding was significantly higher in duodenal GISTs than in gastric GISTs (28.2% vs. 6.6%, P < 0.001), and the re-bleeding rate after endoscopic hemostasis was also higher in duodenal GISTs than in gastric GISTs (41.2% vs. 13.3%, P = 0.118). CONCLUSION In patients with duodenal GIST with old age, large tumor diameter, and mitotic count ≥ 5/HPF, a treatment plan should be established in consideration of the poor prognosis, although tumor bleeding does not adversely affect the prognosis. Duodenal GISTs have a higher incidence of tumor bleeding and re-bleeding rate after endoscopic hemostasis than gastric GISTs.
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Affiliation(s)
- Gyu Young Pih
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Ji Young Choi
- Health Promotion Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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