Endoscopic resection of gastric gastrointestinal stromal tumors (GISTs) could become the preferred option for treating this disease, according to a study recently published in Digestive Endoscopy.
This retrospective study included 117 patients who underwent endoscopic resection of gastric lesions. Analyzing the data from 12 different institutions in Japan, from the first case performed until 2020, the researchers evidenced that the number of procedures increased over the years.
“Recent advancement of endoscopic technique, development of devices to close gastric perforation and Japanese endoscopists’ proficiency for ER procedures are thought to contribute to the increasing trend and good outcomes,” the authors wrote.
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The investigators reported a total of 118 lesions, with tumor sizes that ranged from 8 to 40 mm, and a mean of 20 mm. GIST was the most frequent diagnosis, occurring in 74%, followed by lipomas in 5%, ectopic pancreatic tumors in 2%, and granular cell tumors in 2% of the cases. Almost all (90%) of the lesions displayed an intraluminal type of growth.
All but 1 lesion (99%) were successfully completely resected by the endoscopic approach. However, 3 lesions further required conversion to laparoscopic procedure secondary to uncontrolled bleeding, luminal collapse, or difficulty with closure.
Almost half (44%) of the cases had a full-thickness resection, and 20% needed further abdominal paracentesis for decompression. The surgical time regarding resection varied from 12 to 254 minutes, with an average of 58 minutes. Closing time took 31 minutes on average, with a range of 3 to 330 minutes.
The mean follow-up period was 4.3 years, during which no recurrences were identified. Importantly, the overall survival rate at 5 years was 98.9%.
These results suggest a promising new alternative that is less invasive and may yield fewer adverse events. Although it may not be suitable for all patients, an important proportion of those with a gastric lesion could benefit from this technique.
“Japanese guidelines state that there is no strong evidence to recommend additional surgery for patients who underwent macroscopically negative surgical resection but have histological positive resection margin,” the authors noted.
Shichijo S, Abe N, Takeuchi H, et al. Endoscopic resection for gastric submucosal tumors: a Japanese multicenter retrospective study. Digestive Endoscopy. Published online September 27, 2022. doi:10.1111/den.14446