Survival in patients with hypoechoic muscularis propria lesions suggestive of gastrointestinal stromal tumors in gastric wall.

BACKGROUND: Subepithelial lesions (SEL) on upper gastrointestinal endoscopy are frequently encountered and referred to endoscopic ultrasound (EUS). Management of small gastric hypoechoic SELs of muscularis propria (MP) is controversial since EUS-assisted fine needle aspiration may be inconclusive, and surgical excision may be too invasive. We aimed to analyze our gastric MP-SELs in terms of survival and confounding factors. METHODS: Data from gastric hypoechoic MP-SELs suggestive of gastrointestinal stromal tumor (GIST) by EUS were retrospectively reviewed. Surgically resected GISTs were stratified according to the current pathological risk criteria. RESULTS: Sixty-one patients were identified. The mean age was 55.5 ± 13.2 years and 45.6% were male. Mean follow-up duration was 53.4 ± 26.7 (12-110) months. Twenty-eight (45.9%) patients were managed conservatively (diameter 15.3 ± 10.1 mm). There were no metastasis- or tumor-related deaths and no significant size changes (≥ 5 mm) in this group during follow-up. Thirty-three (54.1%) patients underwent complete resection (diameter 34.2 ± 14.1 mm) among which 25 (75.8%) had the final diagnosis of GIST; 2 (8.0%), 14 (56%) and 6 (24%) patients were classified in no-risk, very-low-risk, low-risk categories respectively, while 2 (8.0%) were in moderate-risk and only 1 (4.0%) was in high-risk category. CONCLUSIONS: The excellent survival of patients with small hypoechoic gastric MP-SELs with conservative management represents indolent course of those lesions. We suggest re- consideration of the recommendations in the current guidelines towards extending the follow-up intervals for small MP-SELs.

Staging of esophageal and gastric cancer in 2014.

Cancers of the upper gastrointestinal (GI) tract; esophageal and gastric carcinomas are highly lethal malignancies that have been ranked among the top 10 most frequent cancers and leading causes of cancer-related mortality. Universally, the tumor-node-metastasis (TNM) staging systems provided by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) are used for esophageal and gastric cancers. Accurate locoregional staging has become critical for the application of appropriate stage-specific treatment options in the multimodality treatment era in order to achieve better patient outcomes. Endoscopic ultrasound (EUS) represents a valuable minimally invasive real-time imaging modality for the assessment of upper GI tract tumors providing evidence for tumor invasion depth and regional nodal involvement corresponding to the T and N status of the TNM staging system, but a clear understanding of its diagnostic performance, limits and complementary role to other imaging modalities is required. This review will focus on the literature about the role and value of EUS in the TNM staging of esophageal and gastric carcinoma. In addition, an overview of the description of the current 7th editions of TNM staging and the revisions of the last editions compared to previous editions are presented.

Signal detection theory approach to gastroesophageal reflux disease: a new method for symptom analysis of impedance-pH data.

An accurate reflux-symptom relationship analysis method is an unmet need in gastroesophageal reflux disease (GERD) diagnosis. The aim of this study was to adapt signal detection theory (SDT) approach to reflux-symptom relationship analysis to develop a new diagnosis method. Patients with predominant symptoms of heartburn and regurgitation were enrolled. Proton pump inhibitor (PPI)-responsive and PPI-unresponsive groups were created via interview and PPI trial. Patients then underwent stationary esophageal manometry and 24-hour multichannel intraluminal impedance-pH monitoring. SDT measurement parameters (discriminability: d' and criterion: c) were calculated using empirically selected time windows (0.5, 1, 2, 3, 4 and 5 minutes). The time window that provided the highest d' value was selected as the optimal time window. A cut-off d' value that optimally separates two groups was found using receiver operating characteristics analysis. Sixty-three patients completed the study (45 PPI responsive). Optimal time window and cut-off d' value were found as 1 and 0.767 minute, respectively. Symptom association probability (SAP) index values showed good correlation (rS = 0.7182, P < 0.0001) with d' values. SDT approach to reflux-symptom relationship analysis showed sensitivity (89% vs. 78%) and negative predictive values (75% vs. 60%) favorable over SAP index analysis. SDT approach using 1-minute time window and 0.767 cut-off d' value provides us a new and more accurate measure of reflux-symptom relationship than SAP index analysis.