Endoscopic treatment for gastrointestinal stromal tumor: Advantages and hurdles

Table 1 Prognostication of gastrointestinal stromal tumor atdifferent sites by tumor size and mitotic rate based on follow-up studies of over 1700 gastrointestinal stromal tumors prior to imatinib

Tumor parameters			Percentage of patients with progressive disease during long-term follow-up and quantitative characterization of the risk for metastasis
Group	Size	Mitotic rate	Gastric GISTs	Small intestinal GISTs	Duodenal GISTs	Rectal GISTs
1	≤ 2 cm	≤ 5/50HPFs	0 none
2	> 2 ≤ 5 cm		1.9 (very low)	4.3 (low)	8.3 (low)	8.5 (low)
3a	> 5 ≤ 10 cm		3.6 (low)	24 (moderate)	34 (high) 1	57 (high) 1
3b	> 10 cm		12 (moderate)	52 (high)
4	≤ 2 cm	> 5/50HPFs	01	501	2	54 (high)
5	> 2 ≤ 5 cm		16 (moderate)	73 (high)	50 (high)	52 (high)
6a	> 5 ≤ 10 cm		55 (high)	85 (high)	86 (high) 1	71 (high) 1
6b	> 10 cm		86 (high)	90 (high)

¹Small number of cases. Groups combined or prognostic prediction less certain;

²No tumors encountered with these parameters. (Adopted from Miettinen et al[4]). HPF: High power field; 50 high: Power fields equal approximately 5 mm²; GIST: Gastrointestinal stromal tumor.

Table 2 Recent publications reporting endoscopic enucleation and endoscopic full-thickness resection for upper gastrointestinal tumors originating from the proper muscle layer

Ref.	n	Method	Mean operation time (min)	Mean tumor diameter (mm)	Complete resection rate (%)	Complications/recurrence
Wang et al[43] (2014)	86	Standard ESD	-	-	100	4 delayed bleedings9 perforations5 local recurrences
Ye et al[47] (2014)	85	ESTD	57	19	100	4 pneumothorax and subcutaneous emphysema2 pneumothorax2 subcutaneous emphysema
Feng et al[49] (2014)	48	EFTR	60	16	100	0
Li et al[48] (2012)	143	ESD (134), EFTR (6), ESTD (3)	45	18	941	2 pneumothorax,1 subcutaneous emphysema
Białek et al[42] (2012)	22	Standard ESD	-	-	681	2 perforations
Liu et al[44] (2013)	31	EMD	77	22	97	4 perforations
Inoue et al[45] (2012)	7	SET	152	19	100	0
Gong et al[46] (2012)	12	ESTD	48	20	83	2 pneumothoraxand subcutaneous emphysema
Zhou et al[52] (2011)	26	EFTR	105	28	100	0
Hwang et al[41] (2009)	25	ESD	-	29	64	3 perforations
Lee et al[40] (2006)	11	ESD	61	21	75	0

¹Pathologically evaluated. EFTR: Endoscopic full-thickness resection; EMD: Endoscopic muscularis dissection; ESD: Endoscopic submucosal dissection; ESTD: Endoscopic submucosal tunnel dissection; SET: Submucosal endoscopic tumor resection.

Table 3 Publications reporting laparoscopic and endoscopic cooperative surgery, laparoscopy-assisted endoscopic full-thickness resection, and non-exposed wall-inversion surgery for submucosal tumors in the upper gastrointestinal tract

Ref.	n	Method	Mean operation time (min)	Mean tumor diameter (mm)	Complete resection rate (%)	Complications
Mitsui et al[61] (2014)	6	NEWS	306	34	100	0
Hoteya et al[59] (2013)	25	LAFER	156	32	1001	0
Tsujimoto et al[56] (2012)	20	LECS	157	38	1001	0
Hiki et al[66] (2011)	38	LECS			100	0
Abe et al[58] (2009)	4	LAEFR	201	30	1001	0
Hiki et al[55] (2008)	7	LECS	169	46	100	0

¹Pathologically evaluated. LAEFR: Laparoscopy-assisted endoscopic full-thickness resection; LECS: Laparoscopic and endoscopic cooperative surgery; NEWS: Non-exposed wall-inversion surgery.