Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2021; 13(6): 462-471
Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.462
Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review
Ze-Ming Chen, Min-Si Peng, Li-Sheng Wang, Zheng-Lei Xu
Ze-Ming Chen, Min-Si Peng, Li-Sheng Wang, Zheng-Lei Xu, Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
Author contributions: Xu ZL conceived the idea for the manuscript; all authors reviewed the literature and drafted the manuscript.
Supported by the Natural Science Foundation of Guangdong Province of China, No. 2018A0303130278.
Conflict-of-interest statement: The author declares no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Zheng-Lei Xu, MD, Associate Professor, Chief Doctor, Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, No. 1017 Dongmen North Road, Shenzhen 518000, Guangdong Province, China. 78249073@qq.com
Received: February 11, 2021
Peer-review started: February 11, 2021
First decision: March 29, 2021
Revised: April 4, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 15, 2021

Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract, but gastric stromal tumors (GSTs) are the most common. All GSTs have the potential to become malignant, and these can be divided into four different grades by risk from low to high: Very low risk, low risk, medium risk, and high risk. Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter. However, it is not clear whether small GSTs (sGSTs, i.e., those smaller than 2 cm in diameter) should be treated as early as possible. The National Comprehensive Cancer Network recommends that endoscopic ultrasonography-guided (EUS-guided) fine-needle aspiration biopsy and imaging (computed tomography or magnetic-resonance imaging) be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment. When EUS indicates a higher risk of tumor, surgical resection is recommended. There are some questions on whether sGSTs also require early treatment. Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective. We here address whether endoscopic therapy is also suitable for sGSTs. In this paper, we try to explain three questions: (1) Does sGST require treatment? (2) Is digestive endoscopy a safe and effective means of treating sGST? and (3) When sGSTs are at different sites and depths, which endoscopic treatment method is more suitable?

Keywords: Gastrointestinal stromal tumors, Small gastric stromal tumors, Malignant, High risk factors, Endoscopy, Treatment

Core Tip: Gastric stromal tumors (GSTs) are all malignant, but generally, the smaller the diameter, the more likely the tumor is inert. However, GSTs smaller than 2 cm in diameter are also at risk of growing and becoming more malignant. Endoscopic treatment of GSTs smaller than 5 cm in diameter is comparable to surgical treatment. Early endoscopic resection is safe and effective when there are high risk factors for GSTs smaller than 2 cm in diameter or the patients cannot be followed regularly, and different endoscopic treatment methods can be selected according to the tumor site and depth.