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Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data

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Abstract

Introduction

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. In recent years, endoscopic procedures such as endoscopic enucleation (EN) and endoscopic full-thickness resection (EFTR) have been used to resect GISTs. This study aimed to investigate the clinical efficacy, safety, and feasibility of endoscopic resection of GISTs in a North American population.

Methods

A total of 25 patients with gastric submucosal lesions (SML) underwent endoscopic resection from December 2014 to April 2016. Data from cases with histologically proven GISTs originating from the muscularis propria layer (MP-GIST) were collected. The main outcome measures were complete resection rate, operative time, postoperative complications, length of hospital stay, narcotic analgesic requirement, and follow-up outcomes. Surveillance was performed with CT abdomen, and/or EGD along with oncology follow-up at 6- to 24-month intervals.

Results

Out of 25 gastric SML, there were 12 histologically proven MP-GIST. Five endophytic MP-GIST were removed by EN, and seven exophytic MP-GIST were removed by EFTR. All lesions were removed en bloc except for one hard to localize exophytic lesion which was completely removed piecemeal. The mean removal time was 79.7 min (range 17–180 min). Nine out of twelve patients required inpatient admission for observation with a mean length of stay of 2.08 days (range 1–4 days). No complications were noted and no narcotic analgesics were required. Pathology reports showed that one GIST was intermediate risk but all others were low-risk lesions. No recurrence has been noted thus far.

Conclusion

Endoscopic removal of MP-GIST by a trained endoscopist appears to be safe and feasible in North American population. Further studies with greater sample size are necessary to compare endoscopic versus surgical resection of MP-GIST. Comparison of outcomes may support wider use of endoscopic techniques for GIST removal.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Iman Andalib & Shahzad Iqbal

  2. Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Daniel Yeoun

  3. Department of Surgery, Kings County Hospital Center, Brooklyn, NY, USA

    Ramesh Reddy

  4. Department of Pathology, Kings County Hospital Center, Brooklyn, NY, USA

    Steve Xie

Authors
  1. Iman Andalib
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  2. Daniel Yeoun
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  3. Ramesh Reddy
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  4. Steve Xie
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  5. Shahzad Iqbal
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Contributions

I.A. and D.Y. drafted the manuscript and completed the statistical analysis for this study. S.X. reviewed the histopathology. R.R. provided surgical back-up, and reviewed the manuscript. S.I. conceived and designed the study, performed all the procedures, completed the paper review, and finalized the paper preparation. All authors read and approved the final paper.

Corresponding author

Correspondence to Iman Andalib.

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Disclosure

Shahzad Iqbal, Iman Andalib, Daniel Yeoun, Ramesh Reddy, and Steve Xie have no conflicts of interest or financial ties to disclose.

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Andalib, I., Yeoun, D., Reddy, R. et al. Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data. Surg Endosc 32, 1787–1792 (2018). https://doi.org/10.1007/s00464-017-5862-9

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  • DOI: https://doi.org/10.1007/s00464-017-5862-9

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