Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumor(Version 2018) / 中华胃肠外科杂志

ABSTRACT

The Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumors is the first guideline in the area of gastrointestinal submucosal tumors(SMT) in China. SMTs of the Gastrointestinal tract are bulge lesions that originate from muscularis mucosa, submucosa, or muscularis propria. Endoscopic treatment of SMT is an effective way to improve the quality of life for patients, to reduce the burden on patients' families and the society, and to save national medical resources. For these reasons, this consensus has proposed the indications for endoscopic resection, on the basis of current status of diagnosis and treatment for SMT in China, and in combination with domestic and foreign literature and experts' experience(1)For tumors with malignant potential suspected by preoperative examination or pathologically confirmed through biopsy, endoscopic resection should be considered when technically possible; (2) Endoscopic resection is indicated for SMT with symptoms (e.g. hemorrhage and obstruction); (3) For benign tumors suspected by preoperative examinations or confirmed by pathological examination, endoscopic resection could be considered when patients cannot attend regular follow-up, tumors grow rapidly in a short period or patients have a strong willing for endoscopic treatment. After endoscopic resection for SMT, different treatment algorithms should be recommended according to pathological types(1)For benign lesions, such as lipoma and leiomyoma, postoperative routine treatment and follow-up are recommended;(2)For SMT without malignant potential, such as well-differentiated rectal neruoendocrine tumors (NET) that are < 1 cm, survival rate after complete resection is approximately 98.9%-100% and the recurrence rate is extremely low. Therefore, routine follow-up is recommended when the margin were confirmed negative pathologically; (3)Low-malignant-potential SMT, such as low-risk GIST, should be assessed by endoscopic ultrasonography or imaging every 6-12 months, and then managed according to clinical instructions; (4)Medium/high-malignant-potential SMT, such as type 3 and type 4 gastric NET, colorectal NET that are >2 cm, and medium/high-risk GISTs, additional treatment is required according to the guidelines for each specific disease. This expert consensus aims to provide an endoscopic SMT diagnosis and treatment standard,which fits our current national status, to domestic hospitals at all levels.