Abstract
Background and Study Aim: In terms of therapeutic management, gastrointestinal stromal tumors (GISTs) seem to be the most difficult group of subepithelial gastrointestinal lesions (SELs). Despite various treatment option, choice of optimal management remains a dilemma in daily practice. Our aim was to evaluate a new hybrid resection technique of gastric GISTs type III as a modality of endoscopic full-thickness resection. Methods: Three males and one female (mean age of 68) were qualified for the procedure. Endoscopic full-thickness resections consisted of the endoscopic resection combined with suturing by Apollo OverStitch System. The main inclusion criterium was a complete diagnosis of GISTs (computed tomography (CT), endoscopic ultrasound (EUS), fine-needle biopsy (FNB)) with the evaluation of the tumor features, especially, the location in the gastric wall. All of the tumors were type III with a diameter between 20–40 mm. The lesions were located in the corpus (1), antrum (1) and between gastric body and fundus (2). All procedures were performed in 2019. Results: The technical and therapeutic success rate was 100% and the mean resection time 107.5 min. Neither intra- nor postprocedural complications were observed. In all four cases, R0 resection was achieved. Histopathologic assessment confirmed GIST with <5mitose/50HPF in all of the tumors, with very low risk. Conclusion: Based on our outcomes, endoscopic resection combined with the sewing by Apollo OverStitch of gastric GISTs type III, with the diameter between 20–40 mm, seems to be an effective therapeutic option with a good safety profile, however further studies with a larger treatment group are needed.
Highlights
Background and Study AimIn terms of therapeutic management, gastrointestinal stromal tumors (GISTs) seem to be the most difficult group of subepithelial gastrointestinal lesions (SELs)
Despite various treatment strategies considering general clinical assessment and the type of tumor according to Miettinen classification, chose of optimal management in daily practice remains a dilemma for some group of tumors
We present a results of combined endoscopic resection technique for type III of gastric GISTs
Summary
In terms of therapeutic management, gastrointestinal stromal tumors (GISTs) seem to be the most difficult group of subepithelial gastrointestinal lesions (SELs). Our aim was to evaluate a new hybrid resection technique of gastric GISTs type III as a modality of endoscopic full-thickness resection. Conclusion: Based on our outcomes, endoscopic resection combined with the sewing by Apollo OverStitch of gastric GISTs type III, with the diameter between 20–40 mm, seems to be an effective therapeutic option with a good safety profile, further studies with a larger treatment group are needed. In terms of therapeutic management, gastrointestinal stromal tumors (GISTs) seem to be the most challenging group of subepithelial gastrointestinal lesions (SELs). Despite various treatment strategies considering general clinical assessment and the type of tumor according to Miettinen classification, chose of optimal management in daily practice remains a dilemma for some group of tumors. Considering the mitotic index as a malignancy predictor andtduiiamtmsoercstle.irAnbfietcelorawlthi1em0cmopnmlfiircismawatitiidooennly,oaafcmcceaoplimtgendpa. nNleceytveperortteheesnleteiscaslt,,iironengcauosleafrotffohGlelIoSwtTu-sumwpiotfhorrthameloldositawmGIseStTefors>rw1ti0thhmetmhe, estimation of malignant potRe0nrteisaelctaionndshhoueladlibne gco.nsidered [1,2,3,4,5,6,7]
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