Gastric Gastrointestinal Stromal Tumors (GIST): a Case Series and Current State of the Art in the Workup and Treatment of This Rare Disease

Gastrointestinal Subepithelial Lesions: Evolution in Management and Endoscopic Resection Techniques

PURPOSE OF REVIEW

Subepithelial lesions (SELs) are tumors originating from the gastrointestinal (GI) tract wall (muscularis mucosa, submucosa, or muscularis propria) and are covered by overlying mucosa. They are typically incidental findings during routine endoscopy. This article reviews the latest advancements in endoscopic techniques and devices used to resect subepithelial lesions.

RECENT FINDINGS

Endoscopic Ultrasound (EUS) should be employed to characterize SELs, with fine needle core biopsy (FNB) utilized with EUS for histopathologic tissue acquisition. EUS can be used as "endoscopic mapping" to mitigate serious complications prior to endoscopic resection. Techniques such as Submucosal Tunnelling Endoscopic Resection (STER), Device-Assisted Endoscopic Full Thickness Resection, and Freehand Full Thickness Resection are available for the complete resection of SELs. The choice of technique depends on the characteristics of the lesion and the level of expertise of the endoscopist. Multiple endoscopic resection techniques for SELs have been developed, each utilizing different tools and devices. A significant shift has occurred from traditional laparoscopic surgical resection to minimally invasive, organ-sparing endoscopic resection. Advancements in "third space" endoscopy and the innovation of novel devices continue to offer less invasive resection techniques for lesions arising from the GI tract wall.

Hybrid surgical approach excision of gastrointestinal stromal tumor (GIST): A case report of GIST at an unusual location and review of the literature

Gastrointestinal stromal tumors are the most common malignant subepithelial lesions involving the gastrointestinal tract. Surgical techniques have been the mainstay of treatment, however, in recent times hybrid surgeries are being introduced yielding better clinical outcomes.

Non-islet cell tumor hypoglycemia associated with Gastrointestinal Stromal Tumor: Case report and review of the literature

Non-islet cell tumor hypoglycemia is an uncommon paraneoplastic phenomenon commonly associated with tumors of mesenchymal origin like gastrointestinal stromal tumors (GIST). It causes the release of insulin-like growth factor type II. GIST are frequently asymptomatic but can present with vague symptoms such as gastrointestinal bleeding, gastric pain, anorexia, nausea, and vomiting. We present an interesting case of A 62-year-old male with GIST tumor admitted for refractory hypoglycemia found to have non-islet cell tumor hypoglycemia which is a relatively uncommon cause of hypoglycemia.

"A hybrid approach for GISTs near the esophagogastric junction, a case report"

Introduction and importance

Gastrointestinal stromal tumors are the most frequent mesenchymal tumors of the gastrointestinal tract. Complete resection of GISTs is the only chance of cure for patients. When these tumors are located near the esophagogastric junction, the surgical risk can cause deformity or stenosis in the gastric inlet, leading to higher complications and diminishing their quality of life. In such cases, a more sophisticated and tailored approach should be used.

Case presentation

We present the case of a 42-year-old female; she presented to our office with a 3-year history of nausea, vomiting and abdominal distension. Two GISTs were located near the EGJ, and with a combined approach we achieved complete resection. On follow-ups, the patient is doing well.

Clinical Discussion, Conclusion

When diagnosis is confirmed, surgical resection must be the first choice for GISTs as complete surgical excision is the only permanent cure. The rise of endoscopic surgery has become a valuable tool and a critical element in surgery. Hybrid techniques that combine laparoscopic and endoscopic approaches can improve the patient's outcomes and provide better results.

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The rise of endoscopic surgery has become a valuable tool and a critical element in surgery.

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Early histologic diagnosis and surgical resection is the most reliable way to improve patients' quality of life.

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The surgical decision will be what define the future of the patient and, ultimately, his life.