Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.171
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
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.
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.
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.
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.
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.
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.
Prospective study involving specific follow-up period for lesions with different initial size may be better to develop an economic strategy for surveillance.