Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2020; 12(4): 171-177
Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.171
Clinical course of suspected small gastrointestinal stromal tumors in the stomach
Lian-Song Ye, Yan Li, Wei Liu, Ming-Hong Yao, Naveed Khan, Bing Hu
Lian-Song Ye, Yan Li, Wei Liu, Naveed Khan, Bing Hu, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Ming-Hong Yao, Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Ye LS, Li Y, Liu W and Hu B made the conception and design; Ye LS, Li Y, Liu W, Yao MH, Khan N and Hu B made analysis and interpretation of the data; Ye LS drafted the article; Li Y, Liu W, Yao MH, Khan N and Hu B made the critical revision of the article for important intellectual content; Ye LS, Li Y, Liu W, Yao MH, Khan N and Hu B made final approval of the article.
Supported by National Key R& D Program of China, No. 2017YFC0112300, No. 2017YFC0112305.
Institutional review board statement: The study protocol was approved by Biomedical Research Ethics Committee, West China Hospital of Sichuan University.
Informed consent statement: Informed consent was waived by the Ethics Committee.
Conflict-of-interest statement: All authors disclose no conflict of interest relevant to this study.
Data sharing statement: No additional data are available.
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:
Corresponding author: Bing Hu, MD, Chief Doctor, Professor, Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China.
Received: December 30, 2019
Peer-review started: December 30, 2019
First decision: February 23, 2020
Revised: February 24, 2020
Accepted: March 26, 2020
Article in press: March 26, 2020
Published online: April 27, 2020
Research background

Gastric subepithelial lesions are frequently encountered during endoscopic examinations, and the majority of them are small and asymptomatic. Among these lesions, gastrointestinal stromal tumors (GISTs) are the major concern for patients and clinicians owing to their malignant potentials. Although previous guidelines suggested periodic surveillance for such small (≤ 20 mm) lesions, several patients and clinicians have still requested or prescribed repeated examinations or radical resection, posing extra medical burdens and risks.

Research motivation

Although several studies demonstrated a low rate of size increment in patients with gastric subepithelial lesions, there were limited investigations involving only suspected small gastric GISTs; the optimal follow-up interval for such lesions remains uncertain.

Research objectives

In this retrospective study, we aimed to describe the clinical course of suspected small gastric GISTs, and to provide further evidence for surveillance strategy for tumor therapy.

Research methods

Consecutive patients with suspected small (≤ 20 mm) gastric GISTs from November 2004 to November 2018 at West China Hospital were retrospectively reviewed. GIST was suspected according to endoscopic ultrasonography features: hypoechoic lesions from muscularis propria or muscularis mucosa. Eligible patients with suspected small GISTs were included for analysis. Patients’ demographic data, lesions’ characteristics, and follow-up medical records were collected.

Research results

A total of 383 patients (male/female, 121/262; mean age, 54 years) with 410 suspected small gastric GISTs (1 lesion in 362 patients, 2 lesions in 16, 3 lesions in 4, and 4 lesions in 1) were included for analysis. The most common location was gastric fundus (56.6%), followed by body (29.0%), cardia (12.2%), and antrum (2.2%). After a median follow-up of 28 mo (interquartile range, 16-48; range, 3-156), 402 lesions (98.0%) showed no changes in size, and 8 (2.0%) lesions increased in size (mean increment, 10 mm). Of the 8 lesions with size increment, endoscopic or surgical resection was performed in 6 patients (5 GISTs and 1 leiomyoma). For other 2 remaining patients, unroofing biopsy or endoscopic ultrasound-guided fine-needle aspiration was carried out (2 GISTs), while no further change in size was noted over a period of 62-64 mo.

Research conclusions

The majority of suspected small (≤ 20 mm) gastric GISTs had no size increment during follow-up. Regular endoscopic follow-up without pathological diagnosis may be highly helpful for such small gastric subepithelial lesions.

Research perspectives

Prospective study involving specific follow-up period for lesions with different initial size may be better to develop an economic strategy for surveillance.