According to a recent World Journal of Surgical Oncology study, new diagnostic techniques such as angiography, enteroscopy, and capsule endoscopy should be used for suspicious lesions for small bowel gastrointestinal stromal tumors (GISTs), which often require a long time to be diagnosed. The study also highlighted that surgical resection is often associated with exceptional postoperative recovery and considerably low recurrence rates.
The study investigated all patients diagnosed with small intestinal GIST between January 2008 and May 2021 at the Mansoura University Gastrointestinal Surgical Center (GIST). The study classified the diagnosed patients with GIST as class 1, 2, and 3 per the American Society of Anesthesiologists (ASA) criteria.
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Thirty-four patients underwent surgical treatment for small bowel GIST with a mean age of 58.1 years and a male-to-female ratio of 1.3:1. The average duration between the onset and diagnosis of the symptoms was reported to be 4.62 years.
Study results of upper GI endoscopy indicated no abnormality in the 32 cases (94.1%), while nonspecific findings (antral gastritis) were found in 2 (5.9%) cases. Moreover, small intestinal lesion diagnosis was made through abdominal computed tomography (CT) in 19 patients (55.9%). Among them, the tumor’s mean size was 8.76 cm, while the lesion was reported to be of ileal origin in 20 cases (58.8%) and jejunal origin in 14 patients (41.2%).
Additionally, 1 patient reported tumor recurrence during the scheduled follow‑up. This tumor recurrence was reported in the small intestine and was managed by resection anastomosis. Furthermore, the presence of a mass was reported to be the most typical symptom (64.7%), followed by melena (52.9%) and abdominal pain (50%). Finally, no mortality cases were reported during the study. “When it comes to pathological classification, half of our cases were low grade, while high-grade lesions were detected in 32.4% of patients,” the authors wrote.
The authors acknowledged several limitations in the study, including the small sample size and the retrospective nature of the study. Therefore, future research may be helpful, including more cases from different surgical centers worldwide, particularly with this rare clinical entity.
Diagnosis of small bowel GISTs presents a challenge for physicians and surgeons due to several factors. Firstly, GISTs are rare, and their symptoms are nonspecific, making diagnosis difficult. Secondly, the wide variation in radiological appearances of GISTs coupled with the presence of surrounding bowel loops can make radiological assessment challenging.
Lastly, conventional endoscopies like upper and lower GI are not effective in visualizing the small intestine, and specialized procedures like enteroscopy or capsule endoscopy are not available in all surgical centers due to high cost. This often leads to misdiagnosis and a prolonged duration of symptoms for patients with small bowel GISTs.
Hamed H, Wahab MA, Elmahdy Y, et al. Gastrointestinal stromal tumors of the small intestine: the challenge of diagnosis and the outcome of management. World J Surg Onc. Published online March 9, 2023. doi: 10.1186/s12957-023-02968-0