Original Article
Clinical value of endoscopic treatment for small gastric stromal tumor
Zhu Lanping, Hui Yangyang, Li Bianxia, Ma Shuang, Chen Xin, Wang Bangmao
Published 2018-12-20
Cite as Chin J Dig Endosc, 2018,35(12): 905-909. DOI: 10.3760/cma.j.issn.1007-5232.2018.12.009
Abstract
ObjectiveTo re-evaluate the potential risk of small gastric stromal tumor (diameter less than 2 cm), and to assess the safety and efficacy of endoscopic resection and further treatment strategy for small gastric stromal tumor.
MethodsData of 584 patients undergoing endoscopic submucosal dissection (ESD) and diagnosed as gastric submucosal tumor (SMT) in Tianjin Medical University General Hospital from September 2008 to December 2015 were retrospectively analyzed. The clinical and pathological features and potential risk of small gastric stromal tumor were analyzed. The therapeutic outcomes, complications and follow-up results of ESD were summarized, and the follow-up results of patients undergoing ESD were compared with 45 patients who were suspected as small gastric stromal tumor and followed-up regularly by endoscopic ultrasonography (EUS) in the same period.
ResultsAmong 584 cases of gastric SMT, stromal tumor (239 cases, 40.9%) was the most common type, of which small gastric stromal tumor was found in 203 cases (84.9%, 203/239). The mitotic index of all cases was no more than 5/50 high power field. However, adverse factors under EUS, mainly including strong echo and heterogeneity, were reported in 94 (46.3%) out of 203 cases and were confirmed to be related to tumor size (P=0.000). ESD was successfully performed in 203 patients with small gastric stromal tumor, and no serious complication or perioperative death occurred. Symptoms of 81.4% (144/177) patients were improved after ESD, and no stromal tumor recurrence or metastasis was observed during a follow-up of 12-84 months. Of the 45 patients followed-up regularly by EUS, 38 (84.4%) patients had gastrointestinal symptoms and 84.2% (32/38) were not relieved during follow-up, and 12 (26.7%) had a heavier psychological burden, seriously affecting the quality of life.
ConclusionThe incidence of adverse factors under EUS is high in patients with small gastric stromal tumor, and increased with tumor size. ESD is safe and effective for small gastric stromal tumor, which contributes to the diagnosis, further improves therapeutic effects and reduces psychological pressure.
Key words:
Stomach neoplasms; Small gastric stromal tumor; Potential risk; Endoscopic resection
Contributor Information
Zhu Lanping
Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China
Hui Yangyang
Li Bianxia
Ma Shuang
Chen Xin
Wang Bangmao
