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Abstract

We appreciate the remarks by Li et al1Li L. Linghu E. Chai N. Endoscopic resection: comparable with surgical resection for treating small-sized gastric GI stromal tumors?.Gastrointest Endosc. 2020; 91: 1411-1412Abstract Full Text Full Text PDF Scopus (4) Google Scholar and their interest in our article.2Kim G.H. Choi K.D. Gong C.S. et al.Comparison of the treatment outcomes of endoscopic and surgical resection of GI stromal tumors in the stomach: a propensity score-matched case-control study.Gastrointest Endosc. 2020; 91: 527-536Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar The authors first pointed out that the number of tumors with diameters ≥3.5 cm should be mentioned. In our study, 3 (5.9%) patients had tumor sizes ≥3.5 cm. The largest tumor was 4.5 cm and was resected in 2 pieces. The other 2 tumors were 4 cm and 3.5 cm and were resected en bloc and retrieved without issues. Previous studies have also reported that submucosal tumors with long diameters ≤5 cm may be completely resected with endoscopy.3Ye L.P. Zhang Y. Luo D.H. et al.Safety of endoscopic resection for upper gastrointestinal subepithelial tumors originating from the muscularis propria layer: an analysis of 733 tumors.Am J Gastroenterol. 2016; 111: 788-796Crossref PubMed Scopus (38) Google Scholar, 4Wang S. Shen L. Efficacy of endoscopic submucosal excavation for gastrointestinal stromal tumors in the cardia.Surg Laparosc Endosc Percutan Tech. 2016; 26: 493-496Crossref PubMed Scopus (15) Google Scholar, 5Tan Y. Tan L. Lu J. et al.Endoscopic resection of gastric gastrointestinal stromal tumors.Transl Gastroenterol Hepatol. 2017; 2: 115Crossref PubMed Scopus (34) Google Scholar, 6Pang T.H. Zhao Y. Fan T. et al.Comparison of safety and outcomes between endoscopic and surgical resections of small (≤5 cm) primary gastric gastrointestinal stromal tumors.J Cancer. 2019; 10: 4132-4141Crossref Scopus (20) Google Scholar Second, the growth patterns and tumor shapes could not be compared between the 2 groups because EUS examinations were not always performed in the surgical resection (SR) group. This issue is mentioned as a limitation in the Discussion section. In the endoscopic resection (ER) group, 47 (92.2%) tumors showed an intraluminal growth pattern and 4 (7.8%) tumors showed an extraluminal growth pattern; 46 (90.2%) tumors were round, 4 (7.8%) were ovoid, and 1 (2.0%) was irregularly shaped; 49 (96.1%) tumors originated from the fourth (muscularis propria) layer, and 2 (3.9%) originated from the second (muscularis mucosa) layer. Finally, we agree that the cost of each method is an important factor. The ER group had a shorter postoperative hospital stay than did the SR group (mean hospital stay, 4.4 ± 2.9 vs 6.6 ± 3.6 days, P < .001). Although we did not carry out a detailed cost analysis on all of the study patients, we selected representative patients from each group and compared their hospital costs. We found that the ER group had a notably lower hospital cost per case than did the SR group (3127 vs 6390 U.S. dollars). All authors disclosed no financial relationships. Endoscopic resection: Comparable with surgical resection for treating small-sized gastric GI stromal tumors?Gastrointestinal EndoscopyVol. 91Issue 6PreviewWe read the article by Kim et al1 with great interest. The authors compared endoscopic resection (ER) with surgical resection (SR) for gastric GI stromal tumors (GISTs) by using propensity score matching. The result showed that ER is an effective and safe therapeutic method for treating small (≤5 cm) gastric GISTs. However, we have the following concerns, and we would appreciate the authors' reply about some details. Full-Text PDF