Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2018; 24(27): 3030-3037
Published online Jul 21, 2018. doi: 10.3748/wjg.v24.i27.3030
Long-term outcomes of endoscopic resection for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors originating from the muscularis propria layer
Yu Zhang, Xin-Li Mao, Xian-Bin Zhou, Hai Yang, Lin-Hong Zhu, Guang Chen, Li-Ping Ye
Yu Zhang, Xin-Li Mao, Xian-Bin Zhou, Li-Ping Ye, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Hai Yang, Department of Radiology, Enze Hospital, Wenzhou Medical University, Taizhou city 318000, Zhejiang Province, China
Lin-Hong Zhu, Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Guang Chen, Department of Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Author contributions: Ye LP performed and analyzed the endoscopy operation; Zhang Y designed the study and drafted the manuscript; Mao XL performed postoperative management; Zhou XB and Zhu LH enrolled patients and acquired the follow-up data; Yang H and Chen G acquired the follow-up data.
Supported by A Project of the Health and Family Planning Commission of Zhejiang Province, No. 2016KYA192.
Institutional review board statement: The study was reviewed and approved by the Institutional Medical Ethics Review Board of Taizhou Hospital of Zhejiang Province.
Informed consent statement: All participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The STROBE Statement have been adopted.
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: Li-Ping Ye, MBBS, Chief Doctor, Professor, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, 150 Ximen Street, Linhai 317000, Zhejiang Province, China. xmcx783@126.com
Telephone: +86-13566866269 Fax: +86-576-85199171
Received: April 13, 2018
Peer-review started: April 14, 2018
First decision: May 21, 2018
Revised: June 15, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: July 21, 2018
Processing time: 96 Days and 15.7 Hours
Abstract
AIM

To evaluate the long-term efficacy of endoscopic resection (ER) for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors (GISTs) originating from the muscularis propria layer.

METHODS

Between June 2005 and February 2015, we retrospectively analyzed 229 consecutive patients with gastric MP-GISTs who underwent ER with a follow-up at least 36 mo. The main outcome measurements included complete resection rate, complications, and long-term follow-up outcomes.

RESULTS

ER included endoscopic muscularis excavation in 179 cases, endoscopic full-thickness resection in 32 cases, and submucosal tunneling endoscopic resection in 18 cases. The median size of GISTs was 1.90 cm. Of the 229 GISTs, 147 were very low risk, 72 were low risk, 8 were intermediate risk, and 2 were high risk. Short-term outcomes showed the complete resection rate was 96.5%, and 8 patients (3.5%) had complications. Of the 8 patients with complications, only one patient required surgical intervention. Long-term outcomes showed 225 patients were actively followed-up until composition of this manuscript. The remaining 4 patients were lost because of unrelated death. During the follow-up period (median, 57 mo), no residual, recurrent lesions, or distant metastasis were detected in any patients. Binary logistic regression analysis showed tumor size was a risk factor associated with a high mitotic index (≥ 5/50 HPF) of GISTs (P = 0.002).

CONCLUSION

ER seems to be an effective and safe method for gastric MP-GISTs ≤ 4.0 cm, and, for some intermediate or high risk GISTs, adjuvant therapy and/or additional surgery might be required to reduce the risk of recurrence or metastasis.

Keywords: Endoscopic resection; Endoscopic full-thickness resection; Submucosal tunneling endoscopic resection; Gastric gastrointestinal stromal tumors; Long-term outcomes

Core tip: The long-term effectiveness of endoscopic resection for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors originating from the muscularis propria layer (MP-GISTs) still remains debatable. In our study, we included a larger sample size with a longer follow-up period to assess the long-term safety and efficacy of ER for gastric MP-GIST. Long-term outcomes showed 225 patients were actively followed-up until composition of this manuscript. The remaining 4 patients were lost because of unrelated death. During the follow-up period (median, 57 mo), no residual, recurrent lesions, or distant metastasis were detected in any patients. Endoscopic resection seems to be an effective and safe method for gastric MP-GISTs ≤ 4.0 cm, and, for some intermediate or high risk GISTs, adjuvant therapy and/or additional surgery might be required to reduce the risk of recurrence or metastasis.