The size of the tumor, its depth of invasion, and the experience of the endoscopist are risk factors for the difficulty of endoscopic gastrointestinal stromal tumor (GIST) resection, according to a new study published in the Journal of Gastroenterology and Hepatology. The authors also developed a nomogram that could screen for non-difficult GIST resection.

Gastric GISTs are one of the most common types of submucosal tumors in the stomach. Without therapeutic intervention, they may spread to other parts of the body and be life-threatening. However, it is difficult to endoscopically resect gastric GISTs. 

To identify the factors that increase the difficulty of endoscopic resection, a team of researchers led by Pinghong Zhou, MD, from the Endoscopy Center of Zhongshan Hospital at Fudan University in Shanghai, China, reviewed gastric GIST patients who were treated at their hospital between June 2009 and June 2020. 

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The patients had a total of 628 GISTs, the clinical and pathological features of which were analyzed. The researchers also collected and analyzed endoscopic procedure information and follow-up data.

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They found that difficulties were encountered during endoscopic resection in 66 cases. GIST sizes of 2 to 3 cm, invasion depth beyond the submucosa, and a lack of experience of the endoscopist were independent risk factors of resection difficulty.

The researchers also developed a nomogram to screen for non-difficult GIST resection, which had a negative predictive value of 94.9% and an accuracy of 79.8%.

The researchers reported, “Follow-up results showed that only five GIST patients had local recurrence after endoscopic resection.”


Su W, Wang M, Zhang D, et al. Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow-up data. J Gastroenterol Hepatol. Published online August 8, 2021. doi:10.1111/jgh.15650

Gastrointestinal stromal tumor (GIST). Mayo Clinic. Published December 2, 2020. Accessed August 13, 2021.