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Gao J, Liu Z, Liu X, Shu X, Zhu Y, Chen Y, Zeng C. Follow-up analysis and research of very low-risk and low-risk gastrointestinal stromal tumors after endoscopic resection. Sci Rep 2024; 14:17872. [PMID: 39090269 PMCID: PMC11294471 DOI: 10.1038/s41598-024-68460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
Currently, due to limited long-term evidence, there remains some controversy surrounding the recommended postoperative monitoring strategy for primary low-risk gastrointestinal stromal tumors (GISTs). This study recruited a total of 532 patients diagnosed with very low-risk and low-risk GISTs who underwent endoscopic resection from 2015 to 2021, including 460 very low-risk patients and 72 low-risk patients. Descriptive statistical analysis was used to evaluate the clinical and pathological characteristics of GIST patients, and Kaplan-Meier methods were employed for survival analysis. The results showed that the 5-year recurrence-free survival rates for very low-risk and low-risk patients were 98.5% and 95.9%, respectively. The 5-year disease-specific survival rates for both groups were 100%. Additionally, the 5-year overall survival rates were 99.7% for very low-risk patients and 100% for low-risk patients (P = 0.69). Therefore, it is suggested that routine follow-up monitoring, including endoscopic surveillance and imaging, may not be necessary for very low-risk and low-risk GISTs after endoscopic resection.
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Affiliation(s)
- Jiaxin Gao
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Zide Liu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xingxing Liu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
| | - Chunyan Zeng
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
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Li J, Xu D, Huang WF, Hong SK, Zhang JY. Efficacy and Safety of Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors Originating from the Muscularis Propria. Dig Dis Sci 2024; 69:2184-2192. [PMID: 38653945 DOI: 10.1007/s10620-024-08359-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The role of endoscopic resection (ER) in gastric gastrointestinal stromal tumors (GISTs) has not been fully elucidated. AIMS The purpose of this work was to evaluate the clinical effectiveness and safety of ER in patients with GISTs originating from the muscularis propria (MP). METHODS A total of 233 consecutive patients with gastric GISTs originating from the MP layer, who underwent ER between February 2012 and May 2023, were included in this study. Clinical characteristics, tumor features, and outcomes were recorded and compared between patients who underwent en bloc resection and piecemeal resection. RESULTS Among the 233 patients, the median size of GISTs was 12 mm (range 5-60 mm). Risk assessment categorized 190 patients as very low risk, 26 as low risk, 10 as moderate risk, and 7 as high risk. The procedures performed included endoscopic submucosal excavation (127 cases), endoscopic full-thickness resection (103 cases), and submucosal tunneling endoscopic resection (3 cases). The complete and R0 resection rate was 93.1%. Complications occurred in 4.7% of cases (perioperative perforations 1.7%, perioperative bleeding 1.3%, both 0.9%), resulting in conversion to surgery in 1.3% of cases. Risk factors associated with piecemeal resection were tumor size [odds ratio (OR) 0.402, 95% confidence interval (CI) 0.207-0.783; P = 0.007] and shape (OR 0.045, 95% CI 0.009-0.235; P < 0.001). CONCLUSIONS ER is proven to be an effective and reasonably safe approach for gastric GISTs originating from the MP. Notably, larger tumor size and irregular shape are identified as risk factors for piecemeal resection during ER procedures.
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Affiliation(s)
- Ji Li
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Dong Xu
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Shao-Kun Hong
- Department of General Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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Xu E, Shi Q, Qi Z, Li B, Sun H, Ren Z, Cai S, He D, Lv Z, Chen Z, Zhong L, Xu L, Li X, Xu S, Zhou P, Zhong Y. Clinical outcomes of endoscopic resection for the treatment of intermediate- or high-risk gastric small gastrointestinal stromal tumors: a multicenter retrospective study. Surg Endosc 2024; 38:3353-3360. [PMID: 38698259 DOI: 10.1007/s00464-024-10753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/14/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND AIMS Many studies of gastric gastrointestinal stromal tumors (g-GISTs) following endoscopic resection (ER) have typically focused on tumor size, with most tumors at low risk of aggressiveness after risk stratification. There have been few systematic studies on the oncologic outcomes of intermediate- or high-risk g-GISTs after ER. METHODS From January 2014 to January 2020, we retrospectively collected patients considered at intermediate- or high-risk of g-GISTs according to the modified NIH consensus classification system. The primary outcome was overall survival (OS). RESULTS Six hundred and seventy nine (679) consecutive patients were diagnosed with g-GISTs and treated by ER between January 2014 and January 2020 in three hospitals in Shanghai, China. 43 patients (20 males and 23 females) were confirmed at intermediate-or high-risk. The mean size of tumors was 2.23 ± 1.01 cm. The median follow-up period was 62.02 ± 15.34 months, with a range of 28 to 105 months. There were no recurrences or metastases, even among patients having R1 resections. The 5-year OS rate was 97.4% (42/43). CONCLUSION ER for intermediate- or high-risk gastric small GISTs is a feasible and safe method, which allows for a wait-and-see approach before determining the necessity for imatinib adjuvant or surgical treatment. This approach to g-GISTs does require that patients undergo close follow-up.
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Affiliation(s)
- Enpan Xu
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiang Shi
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhipeng Qi
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bing Li
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huihui Sun
- Tongji Hospital Affiliated to Tongji University, Shanghai Tongji Hospital, Shanghai, China
| | - Zhong Ren
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shilun Cai
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dongli He
- Shanghai Xuhui Central Hospital, Fudan University, Shanghai, China
| | - Zhengtao Lv
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhanghan Chen
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Zhong
- Huashan Hospital, Fudan University, Shanghai, China
| | - Leiming Xu
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
| | - Xiaobo Li
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Shuchang Xu
- Tongji Hospital Affiliated to Tongji University, Shanghai Tongji Hospital, Shanghai, China
| | - Pinghong Zhou
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunshi Zhong
- Zhongshan Hospital, Fudan University, Shanghai, China.
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Zhang JW, Guo CQ, Zhu SS, Dai N, Liu P, Zhang FB, Zhou HN, Wang JF, Zhou SS, Cao XG. Endoscopic resection of extra-luminal gastric gastrointestinal stromal tumors using a snare assisted external traction technique (with video). Dig Liver Dis 2024:S1590-8658(24)00736-9. [PMID: 38744556 DOI: 10.1016/j.dld.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/10/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The primary purpose of the study was to explore the clinical efficacy of the novel snare assisted endoscopic resection of extraluminal growing gastric gastrointestinal stromal tumors (gastric GISTs) using external traction, and the secondary purpose was to compare the novel snare assisted endoscopic resection of extraluminal GISTs with the standard laparoscopic procedure. METHODS We retrospectively analyzed the patients who underwent novel external traction assisted endoscopic resection or laparoscopic resection for their extraluminal gastric GIST ≤5 cm in diameter. RESULTS A total of 111 patients (27 in the endoscopic group and 84 in the laparoscopic group) were included in this study. There was no significant difference in tumor diameter and complication rate between the two groups. The overall procedure time was slightly higher in the endoscopic group compared to the laparoscopic group (P = 0.034). However, postoperative hospitalization time (P < 0.001) and postoperative fasting time (P = 0.005) were shorter in the endoscopic group compared to the laparoscopic group. CONCLUSION Snare external traction-assisted endoscopic resection of extraluminal growing gastric GISTs is safe and effective, and it provides a new adjunctive method for endoscopic resection of GIST.
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Affiliation(s)
- Jing-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Chang-Qing Guo
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shan-Shan Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Nan Dai
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ping Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Fang-Bin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Hai-Ning Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jian-Feng Wang
- Department of Gastroenterology, Nanyang Central Hospital, Nanyang, 473000, Henan, China
| | - Si-Su Zhou
- Department of Gastroenterology, Nanshi Hospital of Nanyang, Nanyang, 473000, Henan, China
| | - Xin-Guang Cao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Cho JW. Endoscopic resection penetrating the muscularis propria for gastric gastrointestinal stromal tumors: advances and challenges. Clin Endosc 2024; 57:329-331. [PMID: 38725399 PMCID: PMC11133984 DOI: 10.5946/ce.2024.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 05/30/2024] Open
Affiliation(s)
- Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
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Joo MK, Park JJ, Lee YH, Lee BJ, Kim SM, Kim WS, Yoo AY, Chun HJ, Lee SW. Clinical Efficacy and Safety of Endoscopic Treatment of Gastrointestinal Stromal Tumors in the Stomach. Gut Liver 2023; 17:217-225. [PMID: 36789572 PMCID: PMC10018311 DOI: 10.5009/gnl210454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/04/2022] [Accepted: 03/15/2022] [Indexed: 02/16/2023] Open
Abstract
Background/Aims Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the stomach. We evaluated the clinical outcomes of endoscopic treatment for gastric GISTs. Methods This is a single center, retrospective study that enrolled 135 cases of gastric subepithelial tumors (SETs) resected by endoscopic procedures and confirmed as GISTs by histopathology from March 2005 to July 2019. The immediate and long-term clinical outcomes were analyzed retrospectively. Results The mean patient age was 57.9 years, and the mean tumor size was 2.1 cm. Of the tumors, 43.0% were located in the body, followed by the fundus (26.7%) and cardia (17.0%). Most tumors (85.2%) were resected by endoscopic submucosal dissection, followed by endoscopic mucosal resection (6.7%), submucosal tunneling endoscopic resection (5.9%), and endoscopic full-thickness resection (2.2%). Macroperforation occurred in 4.4% and microperforation in 6.7% of the cases. The R0 resection rate was 15.6%. However, the rate of complete resection by the endoscopic view was 90.4%, of which 54.8% of cases were in the very-low-risk group, followed by the low-risk group (28.1%), intermediate-risk group (11.9%), and high-risk group (5.2%). During 36.5 months of follow-up, recurrence was found in four (3.4%) of the 118 patients who were monitored for more than 6 months (low-risk group, 1/37 [2.7%]; intermediate-risk group, 2/11 [18.2%]; high-risk group, 1/6 [16.7%]). Conclusions Endoscopic treatment of a GIST appears to be a feasible procedure in selected cases. However, additional surgery should be considered if the pathologic results correspond to intermediate- or high-risk groups.
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Affiliation(s)
- Moon Kyung Joo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Jae Park
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeon Ho Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Beom Jae Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong Min Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Shik Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ah Young Yoo
- Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Han J, Cho J, Song J, Yang M, Lee Y, Ju M. Endoscopic subserosal dissection for gastric tumors: 18 cases in a single center. Surg Endosc 2022; 36:8039-8046. [PMID: 35441314 DOI: 10.1007/s00464-022-09229-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection has technical limitations for the resection of gastric epithelial tumors with severe fibrosis and mixed or exophytic gastric subepithelial tumors (SETs). AIMS To analyze the safety and effectiveness of endoscopic subserosal dissection (ESSD) for tumors growing in the subserosal space. METHODS This observation study enrolled 18 patients who were diagnosed with gastric tumors and underwent ESSD at the Presbyterian Medical Center from 2010 to March 2019. RESULTS A total of 18 patients were treated by ESSD. The mean age of the patients was 61.7 years. The mean length of the long axis of the tumor was 18.0 ± 5.0 mm. The mean operation time was 44 (range 11-167) min. The pathologic diagnosis was leiomyoma in nine cases (50.0%), gastrointestinal stromal tumor in six (33.3%), low-grade adenoma with severe fibrosis in two (11.1%), and schwannoma in one (5.6%). There were three cases of perforation, which were treated conservatively. The complete resection rate was 94%, and local or systemic tumor recurrence was not seen in a mean 70 months of follow-up. CONCLUSION ESSD can be used for epithelial tumors with severe fibrosis and mixed or exophytic gastric SETs in the lesser curvature, cardia, or fundus that cannot be treated using standard methods.
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Affiliation(s)
- Jihyun Han
- Gastroenterologic Division, Department of Internal Medicine, Presbyterian Medical Center, 365, Seowonro, Wansangu, Jeonju, South Korea
| | - Jinwoong Cho
- Gastroenterologic Division, Department of Internal Medicine, Presbyterian Medical Center, 365, Seowonro, Wansangu, Jeonju, South Korea.
| | - Jaesun Song
- Gastroenterologic Division, Department of Internal Medicine, Presbyterian Medical Center, 365, Seowonro, Wansangu, Jeonju, South Korea
| | - Mina Yang
- Gastroenterologic Division, Department of Internal Medicine, Presbyterian Medical Center, 365, Seowonro, Wansangu, Jeonju, South Korea
| | - Youngjae Lee
- Gastroenterologic Division, Department of Internal Medicine, Presbyterian Medical Center, 365, Seowonro, Wansangu, Jeonju, South Korea
| | - Myoungjin Ju
- Gastroenterologic Division, Department of Pathology, Presbyterian Medical Center, Jeonju, South Korea
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Wang YP, Xu H, Shen JX, Liu WM, Chu Y, Duan BS, Lian JJ, Zhang HB, Zhang L, Xu MD, Cao J. Predictors of difficult endoscopic resection of submucosal tumors originating from the muscularis propria layer at the esophagogastric junction. World J Gastrointest Surg 2022; 14:918-929. [PMID: 36185554 PMCID: PMC9521476 DOI: 10.4240/wjgs.v14.i9.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/05/2022] [Accepted: 08/16/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endoscopic resection approaches, including endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR), have been widely used for the treatment of submucosal tumors (SMTs) located in the upper gastrointestinal tract. However, compared to SMTs located in the esophagus or stomach, endoscopic resection of SMTs from the esophagogastric junction (EGJ) is much more difficult because of the sharp angle and narrow lumen of the EGJ. SMTs originating from the muscularis propria (MP) in the EGJ, especially those that grow extraluminally and adhere closely to the serosa, make endoscopic resection even more difficult. AIM To investigate the predictors of difficult endoscopic resection for SMTs from the MP layer at the EGJ. METHODS A total of 90 patients with SMTs from the MP layer at the EGJ were included in the present study. The difficulty of endoscopic resection was defined as a long procedure time, failure of en bloc resection and intraoperative bleeding. Clinicopathological, endoscopic and follow-up data were collected and analyzed. Statistical analysis of independent risks for piecemeal resection, long operative time, and intraoperative bleeding were assessed using univariate and multivariate analyses. RESULTS According to the location and growth pattern of the tumor, 44 patients underwent STER, 14 patients underwent EFTR, and the remaining 32 patients received a standard ESD procedure. The tumor size was 20.0 mm (range 5.0-100.0 mm). Fourty-seven out of 90 lesions (52.2%) were regularly shaped. The overall en bloc resection rate was 84.4%. The operation time was 43 min (range 16-126 min). The intraoperative bleeding rate was 18.9%. There were no adverse events that required therapeutic intervention during or after the procedures. The surgical approach had no significant correlation with en bloc resection, long operative time or intraoperative bleeding. Large tumor size (≥ 30 mm) and irregular tumor shape were independent predictors for piecemeal resection (OR: 7.346, P = 0.032 and OR: 18.004, P = 0.029, respectively), long operative time (≥ 60 min) (OR: 47.330, P = 0.000 and OR: 6.863, P = 0.034, respectively) and intraoperative bleeding (OR: 20.631, P = 0.002 and OR: 19.020, P = 0.021, respectively). CONCLUSION Endoscopic resection is an effective treatment for SMTs in the MP layer at the EGJ. Tumors with large size and irregular shape were independent predictors for difficult endoscopic resection.
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Affiliation(s)
- Yu-Ping Wang
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
- Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian Province, China
| | - Hong Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
- Department of Gastroenterology and Hepatology, Hangzhou Red Cross Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Jia-Xin Shen
- Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian Province, China
| | - Wen-Ming Liu
- Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, Fujian Province, China
| | - Yuan Chu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Ben-Song Duan
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jing-Jing Lian
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hai-Bin Zhang
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Li Zhang
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Mei-Dong Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jia Cao
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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Yang J, Ni M, Jiang J, Ren X, Zhu T, Cao S, Hassan S, Lv Y, Zhang X, Wei Y, Wang L, Xu G. Comparison of endoscopic full-thickness resection and cap-assisted endoscopic full-thickness resection in the treatment of small (≤1.5 cm) gastric GI stromal tumors. Gastrointest Endosc 2022; 95:660-670.e2. [PMID: 34736933 DOI: 10.1016/j.gie.2021.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/24/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS With the increasing incidence of small GI stromal tumors (GISTs), endoscopic full-thickness resection (EFTR) and cap-assisted EFTR (EFTR-C) have been suggested as 2 effective resection methods. We aimed to compare the outcomes of EFTR and EFTR-C for the treatment of small (≤1.5 cm) gastric GISTs. METHODS This retrospective study included 67 patients who underwent EFTR and 46 patients who underwent EFTR-C at Nanjing Drum Tower Hospital. Clinicopathologic features, adverse events (AEs), and outcomes were compared between the 2 groups. Univariate and multivariate linear and logistic regressions were used to analyze the effects of the procedure on the therapeutic outcomes of patients and adjusted for covariates in the multivariate analysis. RESULTS The tumor size in the EFTR group tended to be larger (P = .005). The resection time in the EFTR-C group was shorter than that in the EFTR group (38.3 ± 20.7 minutes vs 15.0 ± 11.8 minutes, P < .001), which retained statistical significance with adjustment for the covariates (adjusted mean difference, 22.2; 95% confidence interval, 15.0-29.4; P < .001). The R0 resection rate of the EFTR group was 94.0% and of the EFTR-C group 97.8% (P = .355). The EFTR-C group was superior to the EFTR group in terms of perioperative therapeutic outcomes, AEs, and postoperative recovery. No recurrence occurred in the EFTR and EFTR-C groups. CONCLUSIONS EFTR-C was found to be the preferable technique for small (≤1.5 cm) gastric GISTs with shorter operation times, lower AEs, faster postoperative recovery, and shorter hospitalization times as compared with EFTR.
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Affiliation(s)
- Jinping Yang
- Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Jiangsu, China
| | - Muhan Ni
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Jingwei Jiang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Ximei Ren
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Tingting Zhu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Shouli Cao
- Department of Gastroenterology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ying Lv
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Xiaoqi Zhang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Yongyue Wei
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
| | - Guifang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Jiangsu, China; Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China
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Su W, Wang M, Zhang D, Zhu Y, Lv M, Zhu L, He J, Hu H, Zhou P. Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow-up data. J Gastroenterol Hepatol 2022; 37:48-55. [PMID: 34368989 DOI: 10.1111/jgh.15650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Gastrointestinal stromal tumors (GISTs) are among the most common submucosal tumors in the stomach that require therapeutic intervention. We aim to identify the predictors of technical difficulty during endoscopic resection of gastric GIST and to investigate follow-up outcomes. METHODS Patients with gastric GISTs were reviewed from June 2009 to June 2020 at Zhongshan Hospital. Clinical and pathological features, endoscopic procedure information, and follow-up data were collected and analyzed. A nomogram was developed and validated internally and externally. RESULTS A total of 628 GISTs were finally analyzed. The difficulty was experienced in 66 cases. GISTs size (2-3 cm: OR 2.431 P = 0.018 and > 3 cm: OR 9.765 P < 0.001), invasion depth beyond submucosal (MP: OR 2.280, P = 0.038 and MP-ex: OR 4.295, P = 0.002), and lack of experience (OR 2.075, P = 0.016) were independent risk factors of difficulty. The nomogram prediction model showed a bias-corrected C-index value of 0.778 and acquired an area under curve (AUC) of 0.756 on the external validation cohort. At the cut-off of 0.15, the nomogram's negative predictive value (NPV) and accuracy (ACC) were 94.9% and 79.8% in identifying non-difficult GISTs. Follow-up results showed that only five GIST patients had local recurrence after endoscopic resection. CONCLUSIONS Tumor size, invasion depth, and endoscopists' experience were risk factors for the difficulty of endoscopic GIST resection. Our nomogram provided a valuable tool for screening non-difficult GIST resection.
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Affiliation(s)
- Wei Su
- Endoscopy Center of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min Wang
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Danfeng Zhang
- Endoscopy Center of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Zhu
- Endoscopy Center of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Zhu
- Endoscopy Center of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie He
- Endoscopy Center of Zhongshan Hospital (Xiamen Branch), Fudan University, Xiamen, China
| | - Hao Hu
- Endoscopy Center of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pinghong Zhou
- Endoscopy Center of Zhongshan Hospital, Fudan University, Shanghai, China
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11
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Joo MK. Endoscopic Resection of Gastrointestinal Stromal Tumor: Is It Safe? THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2021.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, results from clinical studies of endoscopic resection of gastrointestinal stromal tumor (GIST) in the stomach are being reported. This procedure has several advantages, such as the provision of a definite diagnosis and therapeutic plan, avoidance of frequent follow-up examination, and reduction of patients’ anxiety. However, several concerns also exist such as a limited number of studies, low R0 resection rate, and relatively shorter follow-up period compared with surgical resection. Nevertheless, it is encouraging that most of the post-procedural complications have been treated with conservative management and that some of the patients did not show recurrence of the tumor during long-term follow-up. The selection of suitable cases and the experience of the endoscopists are the most important factors for successful endoscopic resection of gastric GIST. Development of novel procedures as well as collaboration with laparoscopic surgeons are currently in progress.
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12
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Zhang Q, Cai JQ, Wang Z. Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis. Gastroenterol Rep (Oxf) 2020; 9:125-132. [PMID: 34026219 PMCID: PMC8128025 DOI: 10.1093/gastro/goaa050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/30/2019] [Accepted: 02/06/2020] [Indexed: 11/14/2022] Open
Abstract
Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.
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Affiliation(s)
- Qiang Zhang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Jian-Qun Cai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Zhen Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
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13
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Li LY, Li BW, Mekaroonkamol P, Chen HM, Shen SS, Luo H, Dacha S, Xue Y, Cristofaro S, Keilin S, Willingham F, Cai Q. Mucosectomy device-assisted endoscopic resection of gastric subepithelial lesions. J Dig Dis 2020; 21:215-221. [PMID: 32129564 DOI: 10.1111/1751-2980.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Some gastrointestinal subepithelial tumors (SETs) have malignant potential and complete resection may be required. However, endoscopic submucosal dissection (ESD) can be a tedious procedure and requires a long and extensive training to master. Devices for endoscopic full-thickness resection (EFTR) are limited and are not widely available. We report here a simpler endoscopic method to resect small SETs using a commercially available endoscopic mucosal resection (EMR) kit and enucleation technique. METHODS All patients with SET who underwent device-assisted resection at our tertiary care hospital from April 2015 to November 2016 were enrolled in this retrospective study. All procedures were performed by a single expert endoscopist with an advanced endoscopy trainee. A mucosectomy and a limited dissection under mucosa were performed to preserve the mucosa before a device-assisted enucleation of the tumor to facilitate endoscopic closure of the defect closure in all cases. RESULTS A total of 12 patients aged 38-70 y, of whom six were males, were included. Most of the tumors originated from the muscularis propria and were located at the proximal gastric body. The mean procedural duration was 53 minutes (range 23-91 min). The average size of the lesions was 13 mm (range 9-21 mm). The mean duration of hospitalization was 1.3 days. Bleeding and intentional perforation were all successfully managed during the procedure and did not result in any clinically significant adverse event. CONCLUSION A device-assisted EFTR using a commercially available EMR kit is a safe and feasible method for the endoscopic resection of small gastric extrovert SETs.
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Affiliation(s)
- Lian Yong Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bai Wen Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Parit Mekaroonkamol
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Hui Min Chen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shan Shan Shen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Drum Tower Hospital affiliated to the Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Hui Luo
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Sunil Dacha
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Yue Xue
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Sarah Cristofaro
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Steven Keilin
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Field Willingham
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Qiang Cai
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
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14
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Li C, Li L, Shi J. Gastrointestinal endoscopy in early diagnosis and treatment of gastrointestinal tumors. Pak J Med Sci 2020; 36:203-207. [PMID: 32063960 PMCID: PMC6994895 DOI: 10.12669/pjms.36.2.707] [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: 11/15/2022] Open
Abstract
Objective To explore the value of gastrointestinal endoscopy in the early diagnosis and treatment of gastrointestinal tumors and lay a foundation for the diagnosis and treatment of gastrointestinal tumors. Methods One hundred and eight patients with gastrointestinal tumors who were admitted to our hospital from August 2016 to April 2018 were retrospectively analyzed and divided into observation group and control group according to different diagnostic methods, 54 cases in each group. The control group was treated with traditional endoscopy (white light imaging) and traditional surgery, while the observation group underwent narrow band imaging (NBI) based on endoscopic examination and endoscopic mucosal resection. The image quality scores (morphological image, gastric pit image and capillary image), diagnostic accuracy, surgery related clinical indicators (operation time, intraoperative bleeding volume, hospitalization days) and complications were observed and compared between the two groups. Results The morphological image, gastric pit image and capillary image scores of the observation group were higher than those of the control group (P<0.05). The diagnostic accuracy rate of the observation group was 96.30%, which was significantly higher than 75.93% (P<0.05). The operation time and hospitalization days of the observation group were shorter than those of the control group, and the intraoperative bleeding volume of the observation group was less than that of the control group; the differences were statistically significant (P<0.05). The incidence of complications of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05). Conclusion Gastrointestinal endoscopy can accurately identify the pathological changes of tumors in the early diagnosis and treatment of gastrointestinal tumors, improve the diagnostic accuracy rate, and guide the implementation of treatment measures to improve clinical indicators. Moreover the incidence of postoperative complications is low. It is worth clinical promotion.
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Affiliation(s)
- Chunmei Li
- Chunmei Li, Digestive Endoscopy Center, Binzhou People's Hospital, Shandong, 256610, China
| | - Lingzhi Li
- Lingzhi Li, Outpatient Department, Binzhou People's Hospital, Shandong, 256610, China
| | - Juan Shi
- Juan Shi, Department of Cardiothoracic Surgery, Binzhou People's Hospital, Shandong, 256610, China
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15
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Parthasarathi, Dhawal S, Chittawadagi B, Cumar B, Kumar S, Palanivelu C. Gastrointestinal stromal tumour of stomach: Feasibility of laparoscopic resection in large lesions and its long-term outcomes. J Minim Access Surg 2020; 16:348-354. [PMID: 32098941 PMCID: PMC7597867 DOI: 10.4103/jmas.jmas_311_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Gastric gastrointestinal stromal tumours (GISTs) are rare neoplasms that require excision for cure. Although the feasibility of laparoscopic resection of smaller gastric GIST has been established, the feasibility and long-term efficacy of these techniques are unclear in larger lesions. This study is done to assess the feasibility of the laparoscopic resection of gastric GISTs and their long-term outcomes. Methods: Patients who underwent laparoscopic resection of gastric GISTs were identified in a prospectively collected database. Outcome measures included patient demographics, operative findings, morbidity and histopathologic characteristics of the tumour. Patient and tumour characteristics were analysed to identify risk factors for tumour recurrence. Results: There were 42 patients with a mean age of 56.7 years and had a mean tumour size was 4.5 ± 2.7 cm. Laparoscopic wedge resection was the most common procedure done. There were no major perioperative complications or mortalities. All lesions had negative resection margins. At a mean follow-up of 48 months, 36/39 (92.3%) patients were disease free and 3/39 (7.6%) had progressive disease. Univariate analysis showed that there was a statistically significant association of disease progression with tumour size, high mitotic index, tumour ulceration and tumour necrosis. The presence of >10 mitotic figures/50 high-power field was an independent predictor of disease progression. Conclusion: Our study establishes laparoscopic resection is feasible and safe in treating gastric GISTs for tumours >5 cm size. The long-term disease-free survival in our study shows acceptable oncological results in comparison to historical open resections.
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Affiliation(s)
- Parthasarathi
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sharma Dhawal
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Bhushan Chittawadagi
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Bharath Cumar
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Saravana Kumar
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Chinnusamy Palanivelu
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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16
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Zhang Q, Cai JQ, Wang Z, Xiao B, Bai Y. Snare combined with endoscopic clips in endoscopic resection of gastric submucosal tumor: a method of tumor traction. Endosc Int Open 2019; 7:E1150-E1162. [PMID: 31475234 PMCID: PMC6715454 DOI: 10.1055/a-0849-9625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Background and study aims Mucosal traction as a supportive technique is very useful for endoscopists during endoscopy. For gastric submucosal tumor (SMT), our team explored a method of pulling the SMT with a snare combined with endoclips (PSMT-SE). This study preliminarily explored its feasibility to assist resection of gastric SMT. Patients and methods Operation-related data from patients who underwent gastric SMT removal assisted by PSMT-SE at the Gastrointestinal Endoscopy Center of Guangzhou Nanfang Hospital, China between January 2017 and October 2018 were retrospectively collected: tumor size and location, origin of tumor, total operation time, en bloc resection rate, intraoperative and postoperative complications. Results Forty-two gastric SMTs in 41 patients were included in this study. Fifteen tumors were located in the gastric fundus, 11 in the gastric body, two in the gastric angle, 10 in the gastric antrum, and four in the greater curvature of the gastric fundus and the body junction. Further, 11 tumors originated from the submucosa and 31 originated from the muscularis propria. Endoscopic submucosal dissection and endoscopic full-thickness resection assisted by PSMT-SE were performed to resect 30 and 12 tumors, respectively. PSMT-SE could effectively expose the surgical field. Median diameter of resected tumors was 2.0 (0.7) cm, the total operation time was 45.5 (27.0) min, and the en bloc resection rate was 100 %. No intraoperative or postoperative complications were observed. Conclusion PSMT-SE is a potentially useful method for assisting resection of gastric SMT with tumor traction. Further prospective studies with large sample sizes are warranted.
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Affiliation(s)
- Qiang Zhang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jian-qun Cai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhen Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bing Xiao
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yang Bai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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17
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Zhu Y, Xu MD, Xu C, Zhang XC, Chen SY, Zhong YS, Zhang YQ, Chen WF, Chen TY, Xu JX, Yao LQ, Li QL, Zhou PH. Microscopic positive tumor margin does not increase the rate of recurrence in endoscopic resected gastric mesenchymal tumors compared to negative tumor margin. Surg Endosc 2019; 34:159-169. [DOI: 10.1007/s00464-019-06744-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
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18
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Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study. Gastroenterol Res Pract 2018; 2018:2149564. [PMID: 30622559 PMCID: PMC6304882 DOI: 10.1155/2018/2149564] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/20/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023] Open
Abstract
Background Submucosal tumors (SMTs) are primarily benign tumors, but some may have a malignant potential. Endoscopic submucosal dissection that has been used for removing esophageal SMTs could cause perforation. Submucosal tunnel endoscopic resection (STER) is an improved and an effective technique for treating esophageal SMTs. Aims This study was conducted to evaluate the efficacy and safety of STER for treating esophageal SMTs. Methods A retrospective study design was adopted to analyze the baseline characteristics, clinical outcomes, and follow-up data of patients with esophageal SMTs, which originated from the muscularis propria layer and were treated with STER from September 2011 to May 2018. Results A total of 119 lesions were included from 115 patients who were successfully treated with STER. The mean age of the patients was 49.7 ± 10.7 years. The lesions were primarily located in the middle and lower esophagus. The mean size of the lesions was 19.4 ± 10.0 mm. The mean operation duration was 46.7 ± 25.6 min, and the mean duration of hospitalization was 5.9 ± 2.8 days. The total en bloc resection rate and the complete resection rate were 97.5% and 100%, respectively. Regarding complications, there were 9 (7.8%) cases of perforation, 2 (1.7%) cases of pneumothorax, and 9 (7.8%) cases of subcutaneous emphysema. Histopathological results revealed 113 (95.0%) cases of leiomyoma, 5 (4.2%) cases of gastrointestinal stromal tumors, and 1 (0.8%) case of a granular cell tumor. During the mean 15-month follow-up, there were no cases of recurrence and distant metastasis. Conclusions STER is a safe and feasible technique for treating esophageal SMTs originating from the muscularis propria layer.
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Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. The stomach is the most common site of origin. Management of GISTs changed after the introduction of molecularly targeted therapies. Although the only potentially curative treatment of resectable primary GISTs is surgery, recurrence is common. Patients with primary GISTs at intermediate or high risk of recurrence should receive imatinib postoperatively. Imatinib is also first-line therapy for advanced disease. Cytoreductive surgery might be considered in advanced GIST for patients with stable/responding disease or limited focal progression on tyrosine kinase inhibitor therapy. GIST requires multidisciplinary management.
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Affiliation(s)
- Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1484, Houston, TX 77030, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
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20
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Brunaldi VO, Coronel M, Chacon DA, De Moura ETH, Matuguma SE, De Moura EGH, De Moura DTH. Subepithelial rectal gastrointestinal stromal tumor - the use of endoscopic ultrasound-guided fine needle aspiration to establish a definitive cytological diagnosis: a case report. J Med Case Rep 2017; 11:59. [PMID: 28259173 PMCID: PMC5337302 DOI: 10.1186/s13256-017-1205-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/06/2017] [Indexed: 02/06/2023] Open
Abstract
Background Gastrointestinal stromal tumors are the most common mesenchymal neoplasms affecting the gastrointestinal tract. The stomach is the most common location to be affected, and the rectum one of the rarest, but the whole gastrointestinal tract remains susceptible. Gastrointestinal stromal tumors account for only 0.1% of rectal tumors. Currently, endoscopic ultrasound plays an essential role in the diagnostic process of gastrointestinal stromal tumors, especially when the affected sites have a worse outcome and higher morbidity rates. Case presentation We describe the case of a 68-year-old white Japanese man with a history of long-term mild rectal pain and tenesmus. A digital rectal examination revealed a right palpable solid mass ranging from 3 to 7 cm from his anal verge. A colonoscopy was performed and showed a 5 cm elevated lesion covered by normal mucosa, located 4 cm above the pectineal line. Endoscopic ultrasound confirmed the diagnosis of a homogeneous hypoechoic mass with areas of necrosis as a rectal subepithelial lesion originating at the fourth layer (muscularis propria). He then underwent endoscopic ultrasound-guided fine needle aspiration of the lesion, followed by cytological and immunohistochemistry evaluation. The evaluation showed spindle and epithelioid cells of variable sizes, in fascicles separated by stroma, which reacted firmly and consistently to CD117/c-kit and CD34, and negative to desmin and S-100 protein. There was weak staining for nuclear Ki-67 in the tumor cells. A diagnosis of rectal gastrointestinal stromal tumor was confirmed. After a multidisciplinary meeting, an abdominoperineal resection of his rectum was performed. The pathology of the specimen confirmed the diagnosis of rectal gastrointestinal stromal tumor. He is now asymptomatic after 3 months’ follow-up and is on adjuvant therapy with a tyrosine-kinase inhibitor. Conclusions Gastrointestinal stromal tumors are rare tumors, and among the variety of primary location sites, the rectum is one of the rarest. The localization of this type of tumor has worse outcomes and higher morbidity rates. We report this rare case to emphasize the need for precise diagnosis and the important role of endoscopic ultrasound-guided fine needle aspiration in such situations.
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Affiliation(s)
- Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6° andar, bloco 3, Cerqueira Cezar, 05403-010, São Paulo, SP, Brazil
| | - Martin Coronel
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6° andar, bloco 3, Cerqueira Cezar, 05403-010, São Paulo, SP, Brazil
| | - Danielle Azevedo Chacon
- Patology Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, - Andar, bloco -, Cerqueira Cezar, 05403-010, São Paulo, SP, Brazil
| | - Eduardo Turiani Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6° andar, bloco 3, Cerqueira Cezar, 05403-010, São Paulo, SP, Brazil
| | - Sérgio E Matuguma
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6° andar, bloco 3, Cerqueira Cezar, 05403-010, São Paulo, SP, Brazil
| | - Eduardo Guimarães Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6° andar, bloco 3, Cerqueira Cezar, 05403-010, São Paulo, SP, Brazil
| | - Diogo Turiani Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6° andar, bloco 3, Cerqueira Cezar, 05403-010, São Paulo, SP, Brazil.
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Yamauchi K, Iwamuro M, Ishii E, Narita M, Hirata N, Okada H. Gastroduodenal Intussusception with a Gastric Gastrointestinal Stromal Tumor Treated by Endoscopic Submucosal Dissection. Intern Med 2017; 56. [PMID: 28626176 PMCID: PMC5505906 DOI: 10.2169/internalmedicine.56.8160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 95-year-old Japanese woman presented to our hospital with intermittent vomiting and several episodes of melena. Abdominal computed tomography revealed intussusception of the gastric tumor into the duodenum. After endoscopic reduction, endoscopic ultrasonography identified a hypoechogenic lesion limited to the submucosal layer. Endoscopic resection was performed as a localized treatment for the prevention of recurrent gastroduodenal intussusception. To our knowledge, there have been no other reports describing a gastric gastrointestinal stromal tumor presenting with gastroduodenal intussusception and treated using an endoscopic submucosal dissection technique.
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Affiliation(s)
- Kenji Yamauchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | | | - Makoto Narita
- Department of Pathology, Kameda Medical Center, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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22
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Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer. Surg Endosc 2016; 31:3376-3382. [PMID: 27864722 DOI: 10.1007/s00464-016-5350-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Both submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR) are effective method for treating gastric gastrointestinal stromal tumors (GISTs); however, little is known about the comparison between STER and EFTR. The aim of the study was to compare the safety and efficacy of STER and EFTR for treating gastric GIST. METHODS We retrospectively collected the clinical data about patients with gastric GISTs who received STER or EFTR at our hospital from April 2011 to June 2016. Epidemiological data (gender, age), tumor size, procedure-related parameters, complications, length of stay, cost and follow-up data were compared between STER and EFTR. RESULTS A total of 52 patients were enrolled, and 20 of them received STER, while the other 32 cases received EFTR. There was no significant difference between the two groups in terms of gender, age, concomitant diseases, tumor size, en bloc resection rate, operation time, complications, pathohistological grade of GIST, hospital stay and cost (P > 0.05). However, patients who received EFTR had a longer suture time and needed more clips to close the gastric-wall defect (STER vs EFTR, 291.5 ± 68.7 vs 380.6 ± 96.9s and 6.0 ± 1.2 vs 7.6 ± 1.6, P < 0.05). No recurrence was noted in the STER and EFTR groups during a mean follow-up of 10.9 and 23.8 months, respectively. CONCLUSIONS The treatment efficacy between STER and EFTR for treating gastric GISTs was comparable, and a large-scale, randomized study is necessary for a more confirmed conclusion.
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