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Clinical outcomes of endoscopic resection for the treatment of esophageal gastrointestinal stromal tumors: a ten-year experience from a large tertiary center in China

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Abstract

Backgrounds

Esophageal gastrointestinal stromal tumors (E-GISTs) are extremely rare and surgical resection is the recommended approach. However, surgical resection usually causes severe trauma that may result in significant postoperative morbidity. Endoscopic resection (ER) has developed rapidly in recent years and has been widely used in gastrointestinal lesions. Nevertheless, the feasibility and efficacy of ER in the management of E-GISTs are unknown.

Methods

Retrospective data were collected from January 2011 to December 2020 in a large tertiary center of China. Twenty-eight patients with E-GISTs treated by ER were included in the study.

Results

Of the 28 patients, there were 21 males and 7 females, with a median age of 55 years (40–70 years). The median tumor size was 15 mm (5–80 mm). The technical success rate was 100% (28/28), while the en bloc resection rate was 96.4% (27/28). The median operation time was 35 min (10–410 min). Sixteen (57.2%) tumors were categorized into very low risk group, six (21.4%) into low risk group, and six (21.4%) into high risk group. Pathologists carefully examined margins of each lesion. There were 11 lesions (39.3%) determined as R0 resection and 17 lesions (60.7%) as R1 resection with positive margins. The median hospital stay was 2 days (range, 1–8 days). One patient suffered from hydrothorax and required drainage, leading to a major adverse event rate of 3.6% (1/28). There was no conversion to surgery, and no death occurred within 30 days after the procedure. Imatinib was given to two patients after ER under multidisciplinary team surveillance. During follow-up (median of 54 months, 9–122 months), no recurrences or metastasis were observed.

Conclusion

ER is safe and effective for E-GISTs and might become an optional choice in the future. Multicenter, prospective, large samples with long-term follow-up studies are still needed.

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Abbreviations

GIST:

Gastrointestinal stromal tumor

ESD:

Endoscopic submucosal dissection

EFTR:

Endoscopic full-thickness resection

HPF:

High power field

GI:

Gastrointestinal

NCCN:

National comprehensive cancer network

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Funding

This study was supported by grants from National Natural Science Foundation of China (82172787), Shanghai Science and Technology Commission (19ZR1409600), Youth fund of Shanghai Municipal Science and Technology Committee (20194Y0138), and Special fund for clinical research of Zhongshan Hospital (2020ZXLC33).

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  1. Jia-Xin Xu, Tian-Yin Chen and Yan-Bo Liu shared co-first authorship.

Authors and Affiliations

  1. Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Jia-Xin Xu, Tian-Yin Chen, Yan-Bo Liu, Xiao-Yue Xu, Wei-Feng Chen, Quan-Lin Li, Jian-Wei Hu, Wen-Zheng Qin, Ming-Yan Cai, Yi-Qun Zhang & Ping-Hong Zhou

  2. Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China

    Jia-Xin Xu, Tian-Yin Chen, Yan-Bo Liu, Xiao-Yue Xu, Wei-Feng Chen, Quan-Lin Li, Jian-Wei Hu, Wen-Zheng Qin, Ming-Yan Cai, Yi-Qun Zhang & Ping-Hong Zhou

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Contributions

J-XX: writing–original draft. T-YC: writing–original draft. Y-BL: methodology. X-YX: resources. W-FC: resources. Q-LL: resources. J-WH: resources. W-ZQ: resources. M-YC: resources. Y-QZ: conceptualization; supervision; writing–review & editing. P-HZ: writing–review & editing.

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Correspondence to Yi-Qun Zhang or Ping-Hong Zhou.

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Jia-Xin Xu, Tian-Yin Chen, Yan-Bo Liu, Xiao-Yue Xu, Wei-Feng Chen, Quan-Lin Li, Jian-Wei Hu, Wen-Zheng Qin, Ming-Yan Cai, Yi-Qun Zhang, and Ping-Hong Zhou have no conflicts of interest or financial ties to disclose.

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Xu, JX., Chen, TY., Liu, YB. et al. Clinical outcomes of endoscopic resection for the treatment of esophageal gastrointestinal stromal tumors: a ten-year experience from a large tertiary center in China. Surg Endosc 37, 5883–5893 (2023). https://doi.org/10.1007/s00464-023-10032-x

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