Long-term Outcomes Of Endoscopic Resection Of Gastric GISTs

Background and Objective:Gastrointestinal stromal tumors(GISTs)are the most common submucosal tumors of the gastrointestinal tract.They are considered to arise anywhere in the wall of the digestive tract,but especially common in the stomach(60-70%).GISTs have a variable malignancy degree ranging from benign to aggressive,whose biological characteristics are not yet clear.So the surgical removal of the lesions is still the most effective means of treatment.In the past,open surgery or laparoscopic wedge resection was ofen choosed to treat gastric GISTs without metastasis.With the rapid development in endoscopic technology,a variety of endoscopic techniques have been applied in the diagnosis and treatment for them.Recently,there are many researches report that endoscopic submucosal dissection(ESD)and endoscopic ful-thickness resection(EFTR)are successfully used to resect grastic GISTs,including complete excision of large ones.It has been widely accepted that endoscopic resection for gastric GISTs is feasible and safe in the clinical.However,most researches are aimed at discussing the short-term clinical values and complications of endoscopic treatments.The long-term effect remains unclear.In this paper,we retrospectively analyzed the clinical data of 60 patients with gastric GISTs who underwent ESD or EFTR from April 2009 to January 2014 in our hospital.The aims of our study were to assess the long-term feasibility and safety of endoscopic resection for gastric GISTs with no metastasis.Methods:Data of 60 consecutive patients with gastric GISTs who underwent endoscopic resection from April 2009 to January 2014,were collected in terms of the basic information(ID number、 name、gender、age),clinical presentation,tumor size,location,pathology,methods and results of operation,ect.All patients were scheduled for regular follow-up(1,6,and 12 months postoperative and yearly thereafter)by gastroscopy to observe the healing of the wound and recurrence.Also,abdominal ultrasonography was taken yearly to exclude metastasis.Each patient will be scheduled for regular follow-up at least 1 year,with an average follow-up at least 2 years,and then summarize the long-term outcomes of endoscopic treatment for gastric GISTs.Results:Sixty patients underwent successfully complete resection of lesions,including 25 cases of ESD and 35 cases of EFTR,with no accident of tumor rupture or spillage.The average operation time was 43.97 ± 26.95 min(range,11.7–138.9 minutes).The average tumor size was 1.76 ± 1.55 cm(range,0.5-7.6 cm).2 cases were observed with intraoperative hemorrhage of 200 ml blood,which were successfully managed by hemostatic forceps.Perforation for 2-12 mm of ESD occurred in 4 cases(4/25)and were closed well with endoclips,with no conversions to surgical operation.Mucosal laceration of esophagus occurred in 1 case when the big tumor was taken out.The average length of hospitalization was 6.50 ± 3.06 days(range,3–21 days).All patients were followed up for 36.15 ± 12.92 months(range,14–73 months).The primary tumor recurrence occurred in 1 patient who experienced the second operation after 32 months,and others showed no tumor recurrence or metastasis.Conclusion:Endoscopic resection is an effective and safe approach to remove gastric GISTs for long-term outcomes in patients without metastasis.