Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2017; 23(12): 2194-2200
Published online Mar 28, 2017. doi: 10.3748/wjg.v23.i12.2194
Endosonographic surveillance of 1-3 cm gastric submucosal tumors originating from muscularis propria
Ming-Luen Hu, Keng-Liang Wu, Chi-Sin Changchien, Seng-Kee Chuah, Yi-Chun Chiu
Ming-Luen Hu, Keng-Liang Wu, Chi-Sin Changchien, Seng-Kee Chuah, Yi-Chun Chiu, Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
Author contributions: All the authors contributed to this manuscript.
Institutional review board statement: The study was reviewed and approved by Chang Gung Memorial Hospital Institutional Review Board.
Informed consent statement: The data collection in this study is based on reviewing the computerized medical charts.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi-Chun Chiu, MD, Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song District, Kaohsiung 833, Taiwan. chiuku@ms14.hinet.net
Telephone: +886-7-7317123 Fax: +886-7-7322402
Received: October 25, 2016
Peer-review started: October 25, 2016
First decision: December 1, 2016
Revised: December 16, 2016
Accepted: February 16, 2017
Article in press: February 17, 2017
Published online: March 28, 2017
Processing time: 154 Days and 10.1 Hours
Abstract
AIM

To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria (SMTMPs).

METHODS

By reviewing the computerized medical records over a period of 14 years (2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound (EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in 2016.

RESULTS

A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors (GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until 2016.

CONCLUSION

Most 1-3 cm gastric SMTMPs (71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size (> 14.0 mm) and irregular border.

Keywords: Gastrointestinal stromal tumor; Submucosal tumors originating from the muscularis propria; Stomach; Endosonographic surveillance

Core tip: Most gastric submucosal tumors originating from muscularis proprias (SMTMPs) are gastrointestinal stromal tumors (GISTs) or leiomyomas. GISTs have a malignant potential but leiomyomas are benign. We enrolled patients with 1-3 cm gastric SMTMPs and under endoscopic ultrasound surveillance over a period of 14 years between 2000 and 2013 to observe the natural behaviors of such tumors. We also reviewed the patients with progressive tumors again in 2016.