Long-term outcomes of endoscopic resection of gastric GISTs.

Abstract

Although the endoscopic treatment of gastric stromal tumors is a recently accepted therapy, the long-term outcomes of this approach remain unknown. The aims of this study were to assess the long-term effectiveness and safety of endoscopic resection for gastric GISTs. A total of 60 consecutive patients undergoing endoscopic resection of gastric GISTs were enrolled in a retrospective single-center study. Clinical data, perioperative complications, histopathologic characteristics of the tumors, and long-term outcomes were recorded. Sixty patients successfully underwent complete resection of lesions, including 25 cases of endoscopic submucosal dissection (ESD) and 35 cases of endoscopic full-thickness resection (EFTR), with an average tumor size of 1.76±1.55cm (range 0.5-7.6cm). The average operation time was 43.97±26.95min (range 11.7-138.9min). Two cases were observed with an intraoperative hemorrhage of 200mL, which were successfully managed by hemostatic forceps. Perforations of 2-11mm of ESD occurred in four cases (4/25) and were well closed with endoclips, with no conversions to surgical operation. Mucosal laceration of esophagus occurred in 1 case, when a large tumor was removed. The average length of hospitalization was 6.50±3.06days (range 3-21days). Out of a total of 60 patients, 44 (73.3%) were at very low risk, 10 (16.7%) were at low risk, 5 (8.3%) were at intermediate risk, and 1 (1.7%) was at high risk. All patients were followed-up for 36.15±12.92months (range 14-73months). Primary tumor recurrence occurred in 1 patient who underwent a second operation after 32months, and no other cases were observed to have either tumor recurrence or metastasis. For long-term outcomes, endoscopic resection of ESD or EFTR is a safe and effective approach for removing gastric stromal tumors (<5cm), and it can be a resection technique for them with no metastasis.