Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review

Abstract

Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract, but gastric stromal tumors (GSTs) are the most common. All GSTs have the potential to become malignant, and these can be divided into four different grades by risk from low to high: Very low risk, low risk, medium risk, and high risk. Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter. However, it is not clear whether small GSTs (sGSTs, i.e. , those smaller than 2 cm in diameter) should be treated as early as possible. The National Comprehensive Cancer Network recommends that endoscopic ultrasonography-guided (EUS-guided) fine-needle aspiration biopsy and imaging (computed tomography or magnetic-resonance imaging) be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment. When EUS indicates a higher risk of tumor, surgical resection is recommended. There are some questions on whether sGSTs also require early treatment. Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective. We here address whether endoscopic therapy is also suitable for sGSTs. In this paper, we try to explain three questions: (1) Does sGST require treatment? (2) Is digestive endoscopy a safe and effective means of treating sGST? and (3) When sGSTs are at different sites and depths, which endoscopic treatment method is more suitable?

Therapeutic Effects of 4 Surgical Approaches for Small Gastrointestinal Stromal Tumors: A Network Meta-analysis

“…Mutual assistance of 2 scopes can reduce the damage to normal tissues during tumor resection. In addition, therapeutic effects of surgical resection can be examined during surgery 4,25,26. Compared with LR and OpS, ER is less likely to damage the integrity of the gastrointestinal structure.…”

“…Trocar incisions in LR are far smaller than open incisions in OpS, so intraoperative bleeding in LR and LECS may be less than OpS 10,29–31. Moreover, more endoscopic procedures are required in LECS compared with LR, increasing the likelihood of gastrointestinal bleeding 4,32. Complications are important indicators of operation efficacy.…”

“…Besides this, EFR achieves complete tumor resection by actively causing digestive tract perforation, broadening the application scope of ER operation. 4,8 As one of the most concerning postoperative complications for surgeons and patients, recurrence indirectly reflects whether tumors have been completely removed. It is believed that OpS is more thorough in tumor resection and has a lower postoperative recurrence rate, whereas endoscopic operation has poor radical treatment effect, which can easily lead to tumor residue and recurrence.…”

“…In addition, therapeutic effects of surgical resection can be examined during surgery. 4,25,26 Compared with LR and OpS, ER is less likely to damage the integrity of the gastrointestinal structure. As such, it can better preserve gastrointestinal function.…”

“…Because GISTs rarely present diffuse invasive growth or lymph node metastasis, complete tumor resection combined with target drugs is the primary and most effective treatment 2. They can be removed completely using endoscopic resection (ER), laparoscopic resection (LR), laparoscopic endoscopic cooperative surgery (LECS), or open surgery (OpS) 3,4. For large GISTs, endoscopic or laparoscopic operation increases the risk of tumor rupture, bleeding, and cancer cell proliferation.…”