Endoscopic resection of gastrointestinal stromal tumor: The role of clip-and-cut endoscopic full-thickness resection.

Abstract

399 Background: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. We analyzed the results of endoscopic submucosal dissection (ESD) and clip-and-cut endoscopic full-thickness resection (CASE), a modified full-thickness resection method for gastric GISTs to identify the role and its feasibility of CASE. Methods: The medical records of 83 patients diagnosed with GISTs after ER in 2005–2021 were retrospectively reviewed. ESD and CASE were performed in 51 and 32 patients. The clinical characteristics and outcomes were analyzed. Results: The GISTs were mainly found in the upper third of stomach for ESD (52.9%) and CASE (90.6%). In CASE group, there was a tendency that the most of GISTs were in deep muscularis propria or serosal layer (96.9%) compared to ESD group (45.1%). The R0 resection rates were 51.0% in ESD and 84.4% in CASE group, respectively. Perforation during procedure was frequently found in CASE group (25.5% vs. 68.8%), however only three patients were progressed to peritonitis. Seven cases (8.4%) required surgical treatment (6 ESD, 1 CASE) due to residual tumor (n=5), and post-procedure adverse events (n=2). No R0 or R1 resected cases experienced recurrence during the median 14-month follow-up except for one patient in ESD group. Conclusions: CASE showed higher R0 resection rate and was useful and safe in removing small gastric GISTs.