ABSTRACT
BACKGROUND/AIMS: Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinal stromal tumors (GISTs). However, the efficacy of ET remains debatable. In this study, we evaluated the efficacy and safety of ET for GISTs in the upper gastrointestinal tract. METHODS: This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 to July 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, and follow-up were investigated and analyzed. RESULTS: Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the fundus with a mean tumor size of 2.1±1.43 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.29 years, 64.7±35.23 minutes, 6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and 3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence or metastasis. CONCLUSION: ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment of choice for patients with no metastasis.
ABSTRACT
Glomus tumor (GT) is one of the rarest gastrointestinal soft tissue neoplasms. GT in the esophagus has been scarcely reported, and only less than ten cases have been reported. Herein, we report another case of asymptomatic esophageal GT. A 30-year-old male patient was admitted due to incidental finding of esophageal mass on gastroscopy examination. Gastroscopy examination revealed an esophageal mass of 2.0 cm × 1.8 cm. Endoscopic ultrasound (EUS) showed a heterogeneous, hypoechoic mass originated from the submucosal layer and was adjacent to the thoracic aorta. The final diagnosis was confirmed by immunohistochemistry of smooth muscle actin (SMA), vimentin, caldesmon and focal positive of desmin, synaptophysin. The patient underwent submucosal tunneling endoscopic resection (STER) which was effective and the patient was discharged from our hospital 6 days after surgery. Upon 1 year of follow-up, no metastasis was observed. Esophageal GTs lacked specific manifestations and immunohistochemistry was crucial in diagnosis. Endoscopic treatment such as STER is a safe and effective method of treatment.
ABSTRACT
AIMS: To review the clinical presentation, diagnosis, assessment of risk of malignancy, and recent advances in management (mainly focusing on the role of endoscopic resection) of gastrointestinal stromal tumors (GISTs) in upper GI. METHOD: We searched Embase, Web of science, and PubMed databases from 1993 to 2018 by using the following keywords: "gastrointestinal stromal tumors," "GIST," "treatment," and "diagnosis." Additional papers were searched manually from references of the related articles. FINDINGS: The improvement of endoscopic techniques in treating upper gastrointestinal subepithelial tumors especially gastrointestinal tumors has reduced the need for invasive surgery in patients unfit for surgery. Many studies have concluded that modified endoscopic treatments are effective and safe. These treatments permit minimal tissue resection, better dissection control, and high rates of en bloc resection with an acceptable rate of complications.
