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Moga DFC, Vlădoiu G, Frățilă AM, Dan AA, Popa D, Oprea V. Understanding Gastric GIST: From Pathophysiology to Personalized Treatment. J Clin Med 2024; 13:3997. [PMID: 39064037 PMCID: PMC11277334 DOI: 10.3390/jcm13143997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/06/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Gastric gastrointestinal stromal tumors (GISTs) represent a subset of gastrointestinal tumors predominantly found in the stomach. Despite their rarity, these tumors carry significant implications for patient health and management. GISTs are potentially malignant tumors with unpredictable progression. They originate from the interstitial cells of Cajal, which are positioned between the intramural neurons and the smooth muscle cells of the digestive tract. These tumors are characterized primarily by mutations in the c-Kit gene, as well as other mutations such as those in the platelet-derived growth factor receptor alpha (PDGFRA) gene. Methods: Our comprehensive search across five databases initially yielded 2976 articles. After eliminating 197 duplicates, we screened the titles and abstracts of 2779 articles, excluding 2692 for not meeting the inclusion criteria. During the full-text screening, 16 more articles were excluded. Ultimately, 71 papers met the inclusion criteria and were included in our analysis. Results: Due to differences in study designs, inclusion criteria for patients, and reported outcomes, a meta-analysis was not conducted. The accurate diagnosis of GIST is established through histopathological examination and immunohistochemistry. Histopathologically, GISTs are classified into three main types: spindle cell, epithelioid, and mixed. The therapeutic management of GIST involves surgery, endoscopic treatment, and chemotherapy. Conclusions: The prognosis for GIST patients depends on various factors, including risk category, disease stage, applied treatments, and recurrence post-treatment. A significant recent advancement comes from artificial intelligence, which can be increasingly involved in both the diagnosis and treatment of this tumor.
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Affiliation(s)
- Doru-Florian-Cornel Moga
- Clinical Department of Surgery, Military Clinical Emergency Hospital Sibiu, 550024 Sibiu, Romania;
- Department of Dental Medicine and Nursing, Faculty of Medicine, Lucian Blaga University Sibiu, 550024 Sibiu, Romania
| | - Gabriela Vlădoiu
- Department of Dental Medicine and Nursing, Faculty of Medicine, Lucian Blaga University Sibiu, 550024 Sibiu, Romania
- Clinical Department of Neurology, Emergency Clinical County Hospital of Sibiu, 550245 Sibiu, Romania
| | - Anca-Maria Frățilă
- Department of Dental Medicine and Nursing, Faculty of Medicine, Lucian Blaga University Sibiu, 550024 Sibiu, Romania
- Department of Dental Medicine, Military Clinical Emergency Hospital Sibiu, 550024 Sibiu, Romania
| | - Andreea-Alina Dan
- Department of Radiology, Military Clinical Emergency Hospital Sibiu, 550024 Sibiu, Romania;
| | - Daniel Popa
- Department of Gastroenterology, Military Clinical Emergency Hospital Sibiu, 550024 Sibiu, Romania;
| | - Valentin Oprea
- Clinical Department of Surgery, Military Clinical Emergency Hospital Cluj-Napoca, 400132 Cluj-Napoca, Romania;
- Department of Surgery, Faculty of Medicine, Iuliu Hatieganu University Cluj-Napoca, 400012 Cluj-Napoca, Romania
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Ivanov V, Dimov L, Strashilov S, Milkov D, Dzalov N, Chervenkov L. Robotic gastrointestinal stromal tumors surgery - initial results. Folia Med (Plovdiv) 2022; 64:884-888. [PMID: 36876566 DOI: 10.3897/folmed.64.e91448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/15/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) usually present as an exophytic mass localized in stomach. Years ago, conventional surgery was the only option. Laparoscopic and robotic procedures have risen to prominence in recent decades as technology and surgical techniques have advanced.
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Affiliation(s)
| | | | | | - Denis Milkov
- Medical University of Plovdiv, Plovdiv, Bulgaria
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Endoscopy-Assisted Laparoscopic versus Laparoscopic Surgery for Gastrointestinal Stromal Tumor and the Impact on Patients’ Coagulation, Surgical Condition, and Complications. JOURNAL OF ONCOLOGY 2022; 2022:6847321. [PMID: 35368897 PMCID: PMC8967570 DOI: 10.1155/2022/6847321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 12/02/2022]
Abstract
Objective To assess the clinical efficiency of endoscopy-assisted laparoscopic versus laparoscopic surgery for gastrointestinal stromal tumors and the impact on patients' coagulation, surgical condition, and complications. Methods Between November 2016 and May 2020, 126 eligible patients diagnosed with gastrointestinal stromal tumor (GIST) in our institution were recruited. They were concurrently randomly assigned at a ratio of 1 : 1 to receive either laparoscopic gastrectomy (reference group) or endoscopy-assisted laparoscopic gastrectomy (research group). The two groups were compared in terms of patients' coagulation function, surgical conditions, and complications. Results The two groups had similar preoperative coagulation indices and the postoperative levels of activated partial thromboplastin time (APTT) and thromboplastin time (TT) (P > 0.05). Compared with the reference group, the research group showed lower PT levels (10.48 ± 0.68 vs. 11.97 ± 0.46) and higher FIB levels (0.67 ± 0.11 vs. 0.29 ± 0.07) (P < 0.05). Compared with the reference group, the study group had shorter operative time (81.21 ± 10.24 min versus 98.98 ± 15.31 min), shorter surgical incision (3.63 ± 1.12 cm versus 5.01 ± 1.14 cm), and less intraoperative bleeding (18.74 ± 6.98 ml versus 58.69 ± 15.87 ml) (P < 0.05). A markedly shorter length of hospital stay, time to the first postoperative exhaustion, and duration of drainage tube and gastric tube dwelling were observed in the research group versus the reference group (P < 0.05). The study group presented higher nutritional levels of patients at 3 days after surgery and a lower incidence of complication. Conclusion Endoscopy-assisted laparoscopic treatment shows significant improvements in the efficiency of minimally invasive surgery and ensures a better prognosis and quality of life of patients with a good safety profile, so it is worthy of clinical application.
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Kit OI, Gevorkyan YA, Kolesnikov EN, Soldatkina NV, Dashkov AV, Kolesnikov VE. [Gastrointestinal stromal tumors: potential of minimally invasive surgical interventions]. Khirurgiia (Mosk) 2022:25-33. [PMID: 35593625 DOI: 10.17116/hirurgia202205125] [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] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the issue of gastrointestinal stromal tumors (GISTs) and potential of minimally invasive surgical interventions. MATERIAL AND METHODS We analyzed postoperative outcomes in 97 patients with gastric and intestinal GISTs who underwent surgical treatment at the National Medical Research Centre for Oncology between 2015 and 2020. RESULTS Twenty (24.7) patients with gastric GISTs underwent laparoscopic partial and distal gastric resections. Five (35.7%) patients with GISTs of the small intestine underwent minimally invasive segmental bowel resections. Only minimally invasive interventions were performed in patients with rectal GISTs. Analysis of laparoscopic and open surgeries for GISTs found no significant differences. Analysis of laparoscopic and open surgeries for gastric and small bowel GISTs revealed the obvious advantages of minimally invasive access regarding postoperative outcomes. Indeed, we found no need for nasogastric drainage in 50% of patients (p<0.001), earlier recovery of intestinal motility and oral feeding (p<0.001), lower postoperative morbidity (p=0.036), fast recovery of motor activity (p<0.001) and shorter postoperative hospital-stay (p<0.001). CONCLUSION Despite small incidence, GISTs are a complex problem in modern oncology. Diagnosis and treatment require a multidisciplinary medical team (morphologists, geneticists, radiologists, surgeons, chemotherapists, gastroenterologists and other specialists) that is possible in a reference center. Minimally invasive interventions for GISTs of the stomach, small intestine and rectum improve postoperative course.
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Affiliation(s)
- O I Kit
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - Yu A Gevorkyan
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - E N Kolesnikov
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - N V Soldatkina
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - A V Dashkov
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - V E Kolesnikov
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
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Kim DH, Park CH, Park SY, Cho E, Kim HS, Choi SK. Diagnostic yields of endoscopic ultrasound-guided fine-needle tissue acquisition according to the gastric location. Medicine (Baltimore) 2021; 100:e26477. [PMID: 34160458 PMCID: PMC8238348 DOI: 10.1097/md.0000000000026477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023] Open
Abstract
The diagnostic accuracy of endoscopic ultrasound-guided fine-needle tissue acquisition (EUS-FNTA) according to the gastric location of subepithelial tumors (SETs) has not been well established. We aimed to evaluate the efficacy of EUS-FNTA for the diagnosis of gastric SETs according to tumor location.Thirty-three patients diagnosed with gastric SETs via EUS-FNTA from January 2016 to May 2018 were analyzed retrospectively. Patient demographics, diagnostic yields, and complications were evaluated.Nineteen patients (57.6%) were female, with a mean age of 57.7 years. Endoscopic ultrasound revealed a mean longitudinal diameter of 25.6 mm. The most common location of SETs was in the gastric body (n = 18, 54.5%), followed by cardia and fundus (n = 10, 30.3%), and antrum (n = 5, 15.2%). A 20-gauge biopsy needle was most frequently used (90.9%). The diagnostic yield was obtained in 23 patients (69.7%). The most common diagnosis was gastrointestinal stromal tumor (73.9%), followed by leiomyoma (17.4%). The diagnostic yield of SETs in gastric antrum (0/5, 0%) was significantly lower than that in the gastric body and cardia (23/28, 82.1%, P = .001). A case of immediate bleeding after EUS-FNTA occurred in 1 patient (3.0%) who recovered uneventfully. According to related literature, the overall diagnostic yield of SETs in gastric antrum was significantly lower than that in the gastric body, fundus, and cardia (29.7% vs 71.4%, P < .001, n = 191).EUS-FNTA is ineffective in the diagnosis of SETs in the gastric antrum. Although EUS-FNTA is an advanced diagnostic tool for gastric SETs, it is essential to develop more effective methods for the diagnosis of antral SETs.
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Askari A, Brittain R, Hilmi M, Hajuthman W, Al-Bahrani A. Unusual presentations, management and outcomes of gastric stromal tumors: a single-center case series. Ann Gastroenterol 2020; 34:26-32. [PMID: 33414618 PMCID: PMC7774666 DOI: 10.20524/aog.2020.0540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/09/2020] [Indexed: 01/11/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal tumors of the gastrointestinal tract. This study explores the safety of laparoscopy and the long-term oncological outcome in gastroesophageal GIST treatment. Methods A prospectively maintained single-institution database was examined. The variables collected were patient demographics and comorbidities, surgical access (laparoscopic/open), type of surgery, length of stay, and complications. Results A total of 69 patients underwent GIST resection between January 2011 and June 2018, of whom 56.5% were male; the median age was 68 years (interquartile range 60-76). The majority of patients (78.3%, n=54/69) had a laparoscopic resection. Median length of stay was 6 days in the laparoscopic group and 9 days in the open group (P=0.003). Most patients had wedge excision (n=57/69, 82.6%), while 12 patients (17.4%) required a gastrectomy (one a Merendino type). All patients had an R0 resection and 1 patient (1.4%) had a recurrence, despite having a low-risk grade original tumor with negative margins. Patients in the open group had a significantly higher proportion of patients with a high-risk tumor (50%) compared to the laparoscopic group (3.7%, P=0.001). The mean survival was 92.7 months (95% confidence interval 86.3-99.2). Survival was better in the laparoscopic group (100.4 months) compared with the open group (55.1 months, P<0.001). Conclusion Laparoscopic gastric GIST resection is an oncologically safe alternative to open surgery and is associated with a shorter hospital stay with no difference in complication rates or recurrence rates.
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Affiliation(s)
- Alan Askari
- Department of General Surgery, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford (Alan Askari, Rory Brittain, Wasim Hajuthman, Ahmed Al-Bahrani)
| | - Rory Brittain
- Department of General Surgery, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford (Alan Askari, Rory Brittain, Wasim Hajuthman, Ahmed Al-Bahrani)
| | - Marwa Hilmi
- General Practitioner, Lodge Surgery, St Albans (Marwa Hilmi), United Kingdom
| | - Wasim Hajuthman
- Department of General Surgery, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford (Alan Askari, Rory Brittain, Wasim Hajuthman, Ahmed Al-Bahrani)
| | - Ahmed Al-Bahrani
- Department of General Surgery, West Hertfordshire Hospitals NHS Trust, Vicarage Road, Watford (Alan Askari, Rory Brittain, Wasim Hajuthman, Ahmed Al-Bahrani)
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Chernousov AF, Vetshev FP, Vychuzhanin DV, Khorobrykh TV, Egorov AV, Osminin SV, Gelmutdinova ER. [Laparoscopic and robot-assisted procedures in patients with gastrointestinal stromal tumors (GIST) of stomach]. Khirurgiia (Mosk) 2020:5-13. [PMID: 31994494 DOI: 10.17116/hirurgia20200115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To analyze the results of minimally invasive surgical procedures in patients with gastric GIST. MATERIAL AND METHODS The study included 30 patients aged 52.2±9.8 years. ASA grade II (44%), III (26%) and I (23%) were predominant. Lesion of stomach body was noted in 17 (56%) patients, antrum - in 8 (27%), fundus - in 2 (7%) and cardia - in 3 (10%) patients. GIST was located on the anterior wall of stomach in 56% of patients. Exophytic growth was observed in 16 (53%) patients, endophytic - in 12 (40%), transmural growth - in 2 (7%) cases. T2 grade of tumor was noted in 67% of cases (TNM 8). All patients underwent laparoscopic or robot-assisted ('daVinci Si') partial resection of the stomach. RESULTS Radical resection (R0) without injury of pseudocapsule of tumor was made in all patients. Laparoscopic procedures were performed in 25 (83%) patients, robot-assisted - in 5 (17%). Early postoperative complications (Clavien-Dindo II) were observed in 3 patients. Spindle cell structure of tumors (93%) with low mitotic activity (63%) prevailed. Tumor stage I was observed in 56% of patients. Patients with high mitotic tumor index (44%) were directed to targeted therapy. Recurrence and/or metastasis in long-term period were absent in 26 (87%) patients. CONCLUSION Laparoscopic surgery for gastric GIST is safe and characterized by the absence of significant postoperative complications and long-term recurrence-free period. The use of robotic surgical system is effective and justified for anatomically difficult localization of GIST.
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Affiliation(s)
- A F Chernousov
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - F P Vetshev
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - D V Vychuzhanin
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - T V Khorobrykh
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - A V Egorov
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - S V Osminin
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
| | - E R Gelmutdinova
- Chair of Faculty-based surgery #1 Sechenov First Moscow State Medical University of the Ministry of Health of the Russia, Moscow, Russia
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Rodrigues JBSR, Campanati RG, Nolasco F, Bernardes AM, Sanches SRDA, Savassi-Rocha PR. PRE-OPERATIVE GASTRIC GIST DOWNSIZING: THE IMPORTANCE OF NEOADJUVANT THERAPY. ACTA ACUST UNITED AC 2019; 32:e1427. [PMID: 30758475 PMCID: PMC6368167 DOI: 10.1590/0102-672020180001e1427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/07/2018] [Indexed: 01/26/2023]
Abstract
Introduction: Gastric gastrointestinal tumors (GIST) are a rare and usually asymptomatic neoplasm that can present as abdominal mass in more advanced scenarios. Since surgical resection is the main aspect of the treatment, locally advanced tumors require multivisceral resection and, therefore, higher postoperative morbidity and mortality. Objective: To perform a review the literature on the topic, with emphasis on the neoadjuvant therapy. Methods: Literature review on the Medline database using the following descriptors: gastrointestinal stromal tumors, neoadjuvant therapy, imatinib mesylate and molecular targeted therapy. Results: Surgical resection remains the cornerstone for the treatment of GISTs; however, tyrosine kinase inhibitors have improved survival as an adjuvant therapy. More recently, neoadjuvant therapy have been described in the treatment of locally advanced tumors in order to avoid multivisceral resection. Conclusion: Despite surgical resection remains as the most important aspect of the treatment of GISTs, adjuvant and neoadjuvant therapy with tyrosine kinase inhibitors have shown to both improve survival and resectability, respectively.
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Affiliation(s)
| | - Renato Gomes Campanati
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Alfa Institute of Gastroenterology, Belo Horizonte, MG, Brazil
| | - Francisco Nolasco
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Alfa Institute of Gastroenterology, Belo Horizonte, MG, Brazil
| | - Athos Miranda Bernardes
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Alfa Institute of Gastroenterology, Belo Horizonte, MG, Brazil
| | | | - Paulo Roberto Savassi-Rocha
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Alfa Institute of Gastroenterology, Belo Horizonte, MG, Brazil
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Wada AM, Hashiba K, Otoch JP, Brasil H, Marson FP, Cassab J, Abdalla R, Artifon ELA. FULL-THICKNESS ENDOSCOPIC GASTRIC RESECTION USING A STAPLER AND GASTROSTOMY: A FEASIBILITY STUDY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1386. [PMID: 30133678 PMCID: PMC6097028 DOI: 10.1590/0102-672020180001e1386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). AIM To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. METHODS Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. RESULTS Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p<0.05 to <0.001). Of the 562 patients, 26 (4.6%) were classified as failures; 86 (15.3%) fair; 196 (34.9%) good; 144 (25.6%) very good, and 110 (19.6%) excellent results according to the updated BAROS scoring system. CONCLUSION LSG is a highly effective bariatric procedure in the manner of weight control, improvement in comorbidities and increasing of QoL in short- and mid-term.
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Affiliation(s)
| | - Kiyoshi Hashiba
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | | | - Horus Brasil
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | - Fernando P Marson
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | - Jorge Cassab
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
| | - Ricardo Abdalla
- Sírio Libanês Institute for Teaching and Research, São Paulo, SP, Brazil
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Lopes CV, Hartmann AA, Artifon ELDA. EUS-FNA WITH 19 OR 22 GAUGES NEEDLES FOR GASTRIC SUBEPITHELIAL LESIONS OF THE MUSCLE LAYER. ACTA ACUST UNITED AC 2018; 31:e1350. [PMID: 29947684 PMCID: PMC6049997 DOI: 10.1590/0102-672020180001e1350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/08/2018] [Indexed: 12/18/2022]
Abstract
Background: Tissue diagnosis is required for gastric subepithelial lesions for
differential diagnosis of GISTs. However, there has not been consensus about
the best needle for EUS-guided sampling of these lesions. Aim: To evaluate the diagnostic yield of EUS-FNA for gastric subepithelial
lesions of the proper muscle layer with large-bore 19 gauge needles. Methods: A prospectively maintained database was retrospectively reviewed to identify
consecutive patients who underwent EUS-FNA with 19 and 22 gauge needles for
gastric subepithelial lesions of the fourth endosonographic layer in a
tertiary care referral center. EUS-FNA was performed by the same
endosonographer, using the fanning technique, without on-site
cytopathologist. Specimens were analysed through cell blocks by the same
pathologist. Procedure results were categorized into diagnostic, defined as
enough material for histopathology and immunohistochemistry, or
nondiagnostic. Results: Eighty-nine patients (mean age: 59 years, 77% women) underwent 92 EUS-FNA
with 19 (75) or 22 (17) gauge needles. Mean lesion size was 22.6 mm. Overall
diagnostic yield was 88%. The diagnostic yield of 19 gauge was higher than
that of 22 gauge needle (92%x70.6%; p=0.0410), and similar for lesions >2
cm and <2 cm (93.7%x90.7%; p=0.9563). The best performance for 19 gauge
needles was obtained performing <3 needle passes. Complication rate was
2.8%. Conclusions: Diagnostic yield of EUS-FNA with 19 gauge needles is 92% for gastric
subepithelial lesions of the proper muscle layer. It is safe and highly
valuable for differentiation between GIST and leiomyoma, no matter the size
of the lesion.
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DE-Quadros LG, Kaiser-Junior RL, Campos JM, Felix VN, Flamini-Júnior M, Vecchi M, Teixeira A, DE-Santana MF, Zotarelli-Filho IJ. LAPAROENDOSCOPIC TRANSGASTRIC RESECTION OF SUBEPITHELIAL JUXTACARDIAC TUMORS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:143-146. [PMID: 29257852 PMCID: PMC5543795 DOI: 10.1590/0102-6720201700020014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND With a prevalence of 0.4-3.5%, subepithelial lesions of the upper digestive tract are discovered during endoscopic procedures. Treatment depends on etiological and pathophysiological information, ability to diagnose and the different technical resources available. AIM To demonstrate the effectiveness of a surgical technique that combines endoscopy and videolaparoscopy in the transgastric resection of subepithelial juxtacardic lesions. METHOD The patients were assisted with a technical combination between endoscopy and laparoscopy. After diagnosis of subepithelial tumor, intraoperative endoscopy was performed after pneumoperitoneum and placement of laparoscopic tweezers. Through endoscopy, the following steps were performed: demarcation of surgical margins, visualization of the intragastric image for the laparoscopic procedure and removal of the surgical specimen. By laparoscopy the following steps were performed: intragastric intra-abdominal access, resection of the part and closure of the gaps. RESULTS This technique was applied in two cases in order to evaluate its initial results. There were two videolaparoendoscopic resections of juxtacardiac gastric tumors of the posterior wall. Both had their endoscopic diagnosis confirmed. After laparoendoscopic and tomographic and/or ecoendoscopic diagnostic complementation and preoperative performance, the laparoendoscopic procedure was indicated. The patients had a good recovery, with a short hospitalization time and no complications. CONCLUSION The combined use of videolaparoscopy and endoscopy is a safe and effective technique for transgastric resection of juxtacardiac subepithelial lesions. It may be important for definitive diagnosis of the tumor.
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Affiliation(s)
- Luiz Gustavo DE-Quadros
- Kaiser Clinic and Hospital, Endoscopy, São José do Rio Preto, SP, Brazil
- Hospital Beneficência Portuguesa de São José do Rio Preto, Endoscopy, São José do Rio Preto, SP, Brazil
- School of Medicine of ABC, Santo André, SP, Brazil
| | - Roberto Luiz Kaiser-Junior
- Kaiser Clinic and Hospital, Endoscopy, São José do Rio Preto, SP, Brazil
- Hospital Beneficência Portuguesa de São José do Rio Preto, Endoscopy, São José do Rio Preto, SP, Brazil
| | | | | | - Mário Flamini-Júnior
- Kaiser Clinic and Hospital, Endoscopy, São José do Rio Preto, SP, Brazil
- Hospital Beneficência Portuguesa de São José do Rio Preto, Endoscopy, São José do Rio Preto, SP, Brazil
| | - Maurício Vecchi
- Kaiser Clinic and Hospital, Endoscopy, São José do Rio Preto, SP, Brazil
| | | | | | - Idiberto José Zotarelli-Filho
- Kaiser Clinic and Hospital, Endoscopy, São José do Rio Preto, SP, Brazil
- Hospital Beneficência Portuguesa de São José do Rio Preto, Endoscopy, São José do Rio Preto, SP, Brazil
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