Endoscopic resection was found to be safe and effective for small gastric subepithelial tumors (SETs) originating in the muscularis propria that ranged in size between 1 cm and 2 cm including gastrointestinal stromal tumors (GISTs), according to a new study published in BMC Gastroenterology.

“Endoscopic resection may be suitable for the management of patients with small gastric SETs (1-2 cm) in order to confirm diagnosis, to accomplish curative treatment, and to avoid potential malignancy. As for [gastic SETs] (≤ 1 cm), endoscopic and/or radiological surveillance should be recommended,” the authors said.

Current guidelines recommend surveillance and follow-up for gastric SETS less than 2 cm in size but some scholars feel that these tumors should be resected as soon as possible to confirm tumor diagnosis and prevent further malignancy. The study investigated the necessity and safety of endoscopic resection for 972 of these smaller tumors in 935 patients.


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Of the lesions resected, 411 (42.3%) were found to be GISTs on postoperative pathological analysis. Other pathological diagnoses included leiomyoma (n=485; 49.9%), schwannoma (n=20; 2.1%), and ectopic pancreas (n=12; 1.2%) while the remainder were other tumors or tissues (n=44; 4.5%).

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Using the modified National Institutes of Health risk classification system, GIST tumors with a size between 1 cm and 2 cm had higher odds of being classified as intermediate or high-risk compared to those with a size less than 1 cm (odds ratio, 8.41; P <.05). According to the classification system, 376 GIST cases were very low-risk, 25 were low-risk, 8 intermediate-risk, and 2 high-risk.

A previous study noted that diagnosis with a gastric SET and placement on surveillance caused severe psychological illness and affected the quality of life in 27.6% of patients. The authors of this study mentioned that many patients elected to receive endoscopic treatment instead of regular follow-up due to the possibility of malignancy and psychological stress.

“[Besides] GISTs, some other tumors originating from muscularis propria, such as gastric glomus tumor, are also potentially malignant. So in our opinion, we should resect gastric submucosal tumor originating from muscularis propria, if the size is larger than 1 cm,” the authors concluded.

Reference

Hu J, Sun X, Ge N, et al. The necessarity of treatment for small gastric subepithelial tumors (1-2 cm) originating from muscularis propria: an analysis of 972 tumors. BMC Gastroenterol. 2022;22(1):182. doi:10.1186/s12876-022-02256-3