American Gastroenterological Association Institute Technical Review on the Management of Gastric Subepithelial Masses

Hwang, Joo Ha; Rulyak, Stephen J.; Kimmey, Michael B.

doi:10.1053/j.gastro.2006.04.033

Cited by 234 publications

(172 citation statements)

References 98 publications

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“…A portion of gastric SMTs are gastrointestinal stromal tumors (GISTs), which comprise the most common type of gastrointestinal mesenchymal tumors, and have a high potential for malignancy (Hedenbro et al, 1991;Hwang et al, 2006). Until recently, small gastric SMTs originating in the MP layer were primarily treated with surgical techniques (Nishimura et al, 2007;von Schonfeld, 2009;Ryu et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

Wang

Jin

et al. 2017

J. Zhejiang Univ. Sci. B

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Minimally invasive endoscopic resection has been rapidly adopted as a new technique for treating patients with gastric submucosal tumors (SMTs) originating in the muscularis propria (MP) layer. This study was conducted to evaluate the information obtained from endoscopic ultrasonography (EUS) to determine the appropriate endoscopic dissection method for treating SMTs originating in the MP layer. Between February 2014 and May 2016, a total of 50 patients with gastric SMTs originating in the MP layer were enrolled in this study. The clinical features of the patients and their endoscopic, EUS, and histopathologic findings, as well as their postoperative follow-up data, were analyzed in this retrospective study. The mean age of the patients was (55.0±10.2) years, and the male/female ratio was 17:33. Endoscopic submucosal dissection (ESD) was performed on 43 patients and an endoscopic full-thickness resection (EFR) was performed on seven patients. The most frequent location for an SMT was in the upper body region of the stomach (n=16), and the most common pathological diagnosis was a gastrointestinal stromal tumor (GIST) (n=32). The overall rates for complete resection were 95.3% (41/43) and 100.0% (7/7) when the SMTs were treated by ESD and EFR, respectively. The presence of a complete tumor capsule was significantly associated with a complete resection (P=0.001). Of the cases treated by ESD, nine patients developed perforation, one of whom required laparoscopic surgery. The remaining patients were closed with clips or purse-string sutures. The presence of an MP2-type tumor (P=0.018) and a wide connection with the MP layer (P=0.044) were significantly associated with perforation. A preoperative evaluation of the integrity and the location of a tumor capsule and the length of the tumor connection with the MP layer by EUS can improve the complete resection rate and reduce the occurrence of intraoperative complications. Tumors with a complete capsule originating from the superficial MP layer or with a narrow connection with the MP layer are appropriate candidates for treatment by ESD.

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Section: Introductionmentioning

confidence: 99%

Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

Wang

Jin

et al. 2017

J. Zhejiang Univ. Sci. B

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“…Most SETs do not cause symptoms and formerly were considered benign. However, SETs do have a malignant potential, especially when they originate in the muscularis propria layer [2]. Gastrointestinal stromal tumors (GISTs), the most commonly identified intramural SETs in the stomach, have the potential for malignant behavior in 10 to 30% of cases [3][4][5].…”

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confidence: 99%

Endoscopic enucleation for gastric subepithelial tumors originating in the muscularis propria layer

et al. 2010

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“…The initial evaluation of subepithelial lesions can be performed using standard endoscopic equipment and techniques [6,7]. The first step is to visually assess the following features: size, location, shape, color, surface characteristics, presence of pulsation, and change in appearance with patient repositioning and with air insufflation.…”

Section: A Stepwise Approach To the Evaluation Of Subepithelial Lesiomentioning

confidence: 99%

“…However, the management of small, incidentally detected GISTs is controversial, and surgical resection of all such lesions may not be feasible or in the patient's best interest. The National Comprehensive Cancer Network and the European Society for Medical Oncology recommend that all GISTs 2 cm or larger should be resected [64,66], whereas the American Gastroenterolog- ical Association's recommended size threshold for resection is 3 cm (as well as tumors < 3 cm with concerning EUS features) [7]. Studies examining the natural history of small, asymptomatic gastrointestinal subepithelial lesions arising from the muscularis propria suggest that the vast majority do not change significantly over time [67][68][69][70][71].…”

Section: Treatment Of Localized Gistsmentioning

confidence: 99%

“…Type I and II gastric carcinoids that are smaller than 1 cm in size may be managed by annual endoscopic surveillance alone given their extremely low risk of local invasion and metastasis. Endoscopic resection can be considered for type I and type II gastric carcinoids that are 1-2 cm in size and do not invade the muscularis propria on EUS imaging [7,92,93]. Whenever possible, surgical resection and lymph node dissection should be performed for Type III gastric carcinoids given their more aggressive nature.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

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American Gastroenterological Association Institute Technical Review on the Management of Gastric Subepithelial Masses

Cited by 234 publications

References 98 publications

Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

Endoscopic enucleation for gastric subepithelial tumors originating in the muscularis propria layer

Subepithelial Lesions

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