Endoscopic Submucosal Dissection of Large Gastrointestinal Stromal Tumors in the Esophagus and Stomach

Zhankun He; Chao Sun; Zhongqing Zheng; Qingxiang Yu; Tao Wang; Xin Chen; Hailong Cao; Wentian Liu; Bangmao Wang

Disclosures

J Gastroenterol Hepatol. 2013;28(2):262-267. 

In This Article

Abstract and Introduction

Abstract

Background and Aim: Gastrointestinal stromal tumors (GISTs), the most common mesenchymal tumors of the digestive tract with potential for malignant transformation, are mainly treated by open surgery or laparoscopic resection. The aim of this retrospective study was to evaluate the clinical efficacy, safety, and feasibility of endoscopic submucosal dissection (ESD) for large-size (2–5 cm) GISTs in the esophagus and stomach.

Methods: A total of 31 patients with large-size GISTs in the esophagus (6 patients) and stomach (25 patients) underwent ESD between September 2008 and December 2011. Demographics, clinical data, therapeutic outcomes, complications, pathological characteristics, risk classification, and follow-up outcomes were recorded.

Results: ESD was successfully performed in 31 patients at age of 59.06 ± 7.23 years (range: 46–74). The mean time of the procedure was 70.16 ± 16.25 min (range: 40–105). Perforation for 2–10 mm occurred in six patients (19.35%) and was endoscopically repaired with clips or nylon bands, with no conversions to open surgery. Intraoperative bleeding occurred in three patients (9.68%) and was corrected with argon plasma coagulation or hot biopsy forceps. No mortalities occurred. The mean size of the resected tumors was 2.70 ± 0.72 cm (range: 2.0–5.0). Out of the 31 patients, 24 (77.42%) were at very low risk and 7 (22.58%) were at low risk. Positive rate of CD117, DOG-1, and CD34 were 83.87%, 12.90%, and 100%, respectively. A follow up for 14.29 ± 8.99 months (range: 3–39) showed no recurrence or metastasis.

Conclusions: ESD appears to be an effective, safe, and feasible treatment for large-size GISTs in the esophagus and stomach.

Introduction

As the most common subepithelial tumors of the digestive tract,[1,2] gastrointestinal stromal tumors (GISTs) are characterized by an oncogenic disorder of mesenchymal origin and involve dependence upon a structurally mutated tyrosine kinase receptor.[3] They are considered to arise from the interstitial cells of Cajal,[4] and can occupy any location in the GI tract. These tumors have unpredictable biological behavior and the malignant potential is mostly determined by the tumor size and mitotic index.[5] Generally, the conventional treatment of GISTs is open surgery or laparoscopic resection.[6–12] Recently, with the rapid advances in endoscopic technology, endoscopic resection (ER) without laparoscopic assistant has been adopted to treat GISTs.[13,14] Especially, the emergence of endoscopic submucosal dissection (ESD) has made the en bloc resection of lesions arising from submucosal and muscularis propria possible.[15–19] However, only a few data are available for the application of this technique to large-size tumors,[18–20] and further evaluation of this new attempt need to be carried out. With the enrichment of experience in ER and low incidence of complications, we have applied the ESD technique to large-size GI lesions. In this study, we have retrospectively reviewed the data of patients who underwent ESD for GISTs (2–5 cm) in the esophagus and stomach between September 2008 and December 2011, aiming to evaluate the efficacy, safety, and feasibility of ESD in treating these tumors and provide a certain reference for the effective treatment

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