Endoscopic Treatment Of Small Gastric Stromal Tumors And Its Efficacy

Objectives:The objective of this study was to analyze for the safety assessment of the 2 methods:the endoscopic mucosal resection with ligator devices(EMR-L)and endoscopic submucosal dissection(ESD),with gastric stromal tumors<1.2cm.The long-term follow-up after surgery was used to investigate the efficacy of endoscopic treatment of small gastric stromal tumors.Method:This study retrospectively analyzed 83 cases of gastric stromal tumors with a diameter of<1.2 cm diagnosed by postoperative pathological examination and treated with ESD or EMR-L in the Second People’s Hospital of Yunnan Province from January 2010 to January 2017.Preoperative data,intraoperative indicators,postoperative recovery,postoperative pathology,and follow-up results.Preoperative data mainly include age,gender,size of tumor,primary tumor site,and clinical manifestations.Intraoperative indicators include bleeding or perforation during surgery,complete tumor resection rate,and operation time.Postoperative recovery included postoperative hospital stay and surgical wound healing.At the same time,the surgical time,intraoperative complications(perforation or hemorrhage),complete tumor resection rate,postoperative hospital stay,and surgical wounds for the treatment of gastric stromal tumors were compared and analyzed by two endoscopic methods(ESD and EMR-L).Closures were evaluated for the safety of endoscopic treatment of gastric stromal tumors.All patients underwent reexamination of gastroscopes 3 months after surgery to observe the healing of the wounds.Then,gastroscopy was performed once a yearn Follow-up observations were made on the presence or absence of local recurrence of the tumor in the stomach.Abdominal CT scans were performed once a year.Check for distant metastasis of the tumor.The follow-up time of all patients was not less than 1 year,with an average of more than 3 years,so as to explore the long-term efficacy of endoscopic treatment of gastric stromal tumors.Results:1.General information:Statistics from January 2010 to January 2017 in the Second People’s Hospital of Yunnan Province were confirmed by postoperative pathological examination for 83 cases of gastric stromal tumors,the smallest diameter of 0.4cm,the largest diameter 1.2cm,of which patients 0-20 years old accounted for 2 cases,21-40 years old patients 9 cases,41-60 years old patients accounted for 40 cases,61-70 years old patients accounted for 32 cases,the youngest patients were 17 years old,the oldest patients were 70 years old,the median age of onset is 55 years old.There were 46 males and 37 females with a ratio of 1.2 to 1.The primary site of tumor was 60 cases of gastric fundus,21 cases of gastric body and 2 cases of gastric antrum.2.Clinical manifestations and auxiliary examination:In this group of 83 patients with gastric stromal tumors,the clinical manifestations differ greatly.The most common manifestations were abdominal discomfort(abdominal pain,bloating)in 53 cases,accounting for 63.9%;followed by no obvious clinical symptoms,physical examination(abdominal B-ultrasound,abdominal CT or gastroscopy)was found inadvertently in 25 cases,accounting for 30.1%;there were 4 cases of upper gastrointestinal bleeding(such as anemia,black stools),accounting for 4.8%,found in 1 case of abdominal mass,accounting for 1.2%.3.Preoperative examination:83 patients with gastric stromal tumors in this group received preoperative gastroscopy,abdominal CT,and ultrasound-assisted endoscopy(EUS)-related auxiliary examination.All patients did not indicate the presence of proximal or distant organ metastases.4.Distribution of tumor size,mitotic figures and biological behavior:In this study,83 cases of gastric stromal tumors were studied.The tumor diameter ranged from 0.4cm to 1.2cm with a median of 0.70cm.Among them,46 cases(55.4%)had no mitotic 0/50%HPF under microscopy,21 cases(25.3%)had mitoses like 1-2/50 HPF under microscope,and 15 cases(18.1%)had mitoses like 3-5/50 HPF.In 1 case(1.2%),the mitotic figures were>5/50 HPF.Of these,82 were classified as having a very low risk according to the NIH risk classification.The remaining 1 patient had a small GST of>5/50 HPF under the microscopic microscope and could be classified as having the malignant potential undefined according to the AFIP classification.5.Treatment:All the 83 patients studied in this study were treated with endoscopic surgery.Among them,35 patients were treated with ESD,and 48 patients were treated with EMR-L.In the ESD group,all tumors reached complete resection and no tumor rupture.The complete tumor resection rate was 100%.In the EMR-L group,46 cases reached complete tumor resection(46/48).The complete tumor resection rate was 95.8%.In the ESD group,bleeding occurred in 2 patients during the operation.The bleeding amount varied from 5ml to 10ml.Electrocoagulation was used to perform electrocoagulation for hemostasis.Delayed bleeding did not occur after surgery.In the ESD group,perforation occurred in 4 cases.The diameter of the hiatal hernia was 0.8 cm to 1.2 cm,and the perforation rate was 11.4%.In the EMR-L group,there were no cases of hemorrhage,and 2 cases had perforations during operation.The diameters of the holes were 1.0 cm and 1.2 cm,respectively.Two groups of intraoperative perforation cases were gradually closed with purse-string sutures or metal titanium clips from both ends of the perforation site to the center.No surgery was performed in all cases.All patients were not treated with oral imatinib mesylate after surgery.Compared ESD and EMR-L results,ESD was longer than EMR-L operation time,p<0.05;the differences in operation time,intraoperative perforation,hemorrhage,complete tumor resection rate,and postoperative hospital stay were different in both groups.No statistical significance,p>0.05.6.Immunohistochemistry:83 cases of this group of patients were pathological and immunohistochemical confirmed GST,CD117 positive was 76(91.6%),CD34 positive was 80 cases(96.4%),DOG-1 positive in 50 cases(60.2%),S-100 positive was 14 cases(16.9%),SMA positive was 25 cases(30.1%),and Desmin positive was 0 case(0%).7.Follow-up of the prognosis:Of the 83 patients in this study,83 were followed up and the follow-up rate was 100%.The minimum follow-up time was 12 months and the longest was 78 months.The median follow-up time was 39 months.Among the 83 follow-up cases,all patients had good wound healing and no recurrence or distant metastasis.Conclusion:1.Stomach stromal tumors(diameter ≤ 1.2cm)endoscopic EMR-L or ESD surgical approach can achieve complete resection of the lesion to ensure the integrity of pathological specimens,and the incidence of intraoperative complications is low,no need to turn into the surgical treatment,endoscopic treatment of gastric stromal tumors using EMR-L or ESD is safe and reliable.2.The recurrence and metastasis of the patients after follow-up were observed.It indicated that the endoscopic treatment of gastric stromal tumors with ESD or EMR-L was effective.