Efficacy and safety of endoscopic resection for gastric subepithelial tumors.

Abstract

107 Background: Because small gastric subepithelial tumors (SETs) less than 2.0 cm might have malignant potential, ambiguous cases should be removed for optimal diagnosis and treatment. With the recent advances in endoscopic technique, endoscopic resection (ER) has been attempted for pathologic confirmation of gastric SETs. Herein, we aim to investigate the clinical usefulness and safety of ER of gastric SETs. Methods: A total of 115 subjects who underwent ER for gastric SETs from January 2005 to December 2014 were eligible for the study at the Asan Medical Center, Seoul, Korea. Patient’s demographic status, tumor related factors, procedure related factors, and clinical outcomes were retrospectively reviewed by using electronic medical record. Results: Among the 115 patients, 53 were male (46.1%) and the mean age was 51.59 ± 14.59 years. The mean size of all tumors was 18.58 ± 10.71 mm. Complete endoscopic resection was achieved in 108 of 115 tumors (93.9%). The final histopathologic diagnoses included 38 gastrointestinal stromal tumors (GISTs) (33.0%), 21 heterotopic pancreas (18.3%), 18 neuroendocrine tumors (15.7%), 11 leiomyoma (9.6%), 10 inflammatory fibroid polyp (8.7%), and others tumors (n = 17, 14.8%). Perforations occurred in 12 patients (10.4%) and they were successfully managed with endoscopic clipping. Severe bleeding during endoscopic resection occurred in 13 patients (11.3%) and they were treated by endoscopic management. Six patients underwent sequential wedge resection or gastrectomy of stomach because of non-curative resection and the pathologic evaluation revealed residual tumors in 3 patients. There was no recurrence or metastasis during mean follow-up of 44.96 ± 32.62 months (range 3-120.7 months). The rate for complete resection in relation to the final pathology was lower in GISTs (86.8%) than others (97.4%, p = 0.026). The rate of perforation was significantly higher for the fundus (66.7%) than for other locations (0% for the cardia, 16.7% for high body, 8.3% for mid body and 8.3% for antrum) (p < 0.001). Conclusions: ER of gastric SETs may be feasible and safe method for pathologic confirmation and further strategy.