Clinical Efficacy Analysis Of Endoscopic Submucosal Dissection In The Treatment Of Gastric Gastrointestinal Stromal Tumor

BackgroundGastrointestinal stromal tumors（GISTs）are the most common mesenchymal tumors of the digestive system,and their pathogenesis sites can involve the whole digestive tract,and most of them are distributed in the stomach.Since gastric gastrointestinal stromal tumor has a tendency to malignancy and rarely occurs lymph node metastasis,surgical resection is mainly carried out at present.However,open surgery and laparoscopic surgery have great trauma to the body,so endoscopic resection has been widely concerned in recent years.Meanwhile,Endoscopic submucosal dissection（ESD）showed many advantages in the treatment of early gastric cancer,esophageal cancer and other diseases.Besides,with the continuous updating of inspection technology,the detection rate of gastric gastrointestinal stromal tumor is increasing year by year.In order to provide a new treatment option for patients with gastric gastrointestinal stromal tumor,it is necessary to further explore the efficacy and safety of ESD in the treatment of gastric gastrointestinal stromal tumor.ObjectivesTo investigate the clinical efficacy and safety of endoscopic submucosal dissection versus laparoscopic surgery for gastric gastrointestinal stromal tumor.MethodsData of 73 patients with gastric gastrointestinal stromal tumor who were treated in the Department of Gastroenterology and Gastrointestinal Surgery in the First Affiliated Hospital of Xinxiang Medical University from January 2018 to July 2020 and confirmed by histopathology were retrospectively analyzed.According to the different surgical methods,the patients were divided into ESD treatment group and laparoscopic surgery group.The general clinical characteristics,pathological data,and postoperative indicators of the two groups were compared,and the effect of other factors on postoperative results was analyzed by Covariance analysis.Results1.Comparison of general clinical featuresPatients in the ESD group had smaller tumor diameter（1.54±0.60 cm,P<0.001）and higher hemoglobin（131.60±13.12g/L,P < 0.001）compared with the surgical group.In addition to abdominal pain and bloating,the symptoms of melena and hematemesis were more common in the surgical group than in the ESD group.There were no statistical differences between the two groups in sex,age,tumor site,lesion invasion depth,FAR,PLR and NLR（P>0.05）.2.Comparison of risk classification and pathological resultsThe ESD group was mainly at very low risk（73.81%）,and the surgical group was mainly at low risk（51.61%）,there was a statistical difference in risk classification between the two groups（P<0.001）.There were no statistical differences in the number of mitosis and cell type distribution between the ESD group and the surgical group（P>0.05）.3.Comparison of postoperative resultsThe ESD group had shorter mean operation time（96.90±29.09 min,P<0.001）,shorter mean length hospital stay（7.93±2.30 d,P<0.001）,shorter mean fasting time（5.29±1.33 d,P<0.001）,less median blood loss（7.5ml,P<0.001）,and lower the mean surgical cost（3898.99±914.04 yuan,P < 0.001）and the mean total hospitalization cost（21676.78±6547.27 yuan,P<0.001）than surgical group.Perforation occurred in 3 cases amd hemorrhage occurred in 1 cases in the ESD group,while hemorrhage occurred in 4cases and postoperative infection occurred 1 case in the surgical group,there was no statistical difference in overall complications between the two groups（9.52% vs 16.13%,P>0.05）.Patients in both groups achieved en bloc resection and complete resection,and no recurrence was found during the follow-up period.Covariance analysis was used to adjust the effect of tumor size、clinical manifestations and hemoglobin on postoperative results.The results showed that after adjusting for tumor size 、 clinical manifestations and hemoglobin indicators,the operation time,hospital stay and fasting time of the ESD group were significantly shorter than those of the surgery group,and the differences were statistically significant（P< 0.05）.ConclusionThe efficacy of ESD in the treatment of gastric gastrointestinal stromal tumor is similar to that of the laparoscopic resection,and it has many advantages such as short operation time,less blood loss,and quick recovery,which can be used as a new minimally invasive treatment for gastric gastrointestinal stromal tumor.