Endoscopic Characteristics, Risk Grade, and Prognostic Prediction in Gastrointestinal Stromal Tumors of the Small Bowel

Abstract

Background/Aims: Balloon-assisted endoscopy allows us to diagnose gastrointestinal (GI) stromal tumors (GISTs) in the small bowel including endoscopic ultrasonography and taking biopsy. The aim of this study was to retrospectively clarify clinical and endoscopic characteristics of small bowel GISTs using double-balloon endoscopy (DBE). Methods: We reviewed 25 patients who underwent DBE and were diagnosed with GISTs. The risk of GISTs was stratified using the National Institute of Health (NIH) consensus criteria. We evaluated the available DBE route, the diagnostic yield of biopsy examination, and the relationship between endoscopic characteristics and recurrence-free survival (RFS). Results: Of all 25 patients, 23 had any endoscopic findings related to GIST. They were detected using the antegrade approach in 91.3%. GISTs were classified into high risk (n = 7), intermediate risk (n = 4), low risk (n = 10), and very low risk (n = 4) based on surgical specimens. The diagnostic result of biopsy was 46.7% (7/15), but it was difficult to predict the NIH risk group. Endoscopic characteristics were not associated with RFS. The NIH risk group was significantly associated with RFS. Conclusions: Antegrade DBE was preferable for exploring small bowel GIST, but the diagnostic ability of biopsy examination was limited.

Effect of Double-Balloon Enteroscopy on Diagnosis and Treatment of Small-Bowel Diseases

“…If bleeding is profuse, patients may experience dizziness, weakness, pale skin and conjunctiva, and even syncope and shock. [ 14 ] The main methods for diagnosing SIST are digestive tract X-ray, abdominal computed tomography, capsule endoscopy, and double-balloon enteroscopy. In our study, diagnosis by double-balloon enteroscopy had the advantage of confirming the size of the tumor and verifying the pathological diagnosis with biopsy.…”

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

“…In all other cases, histological confirmation is crucial to make treatment decisions [83,90,91]. Biopsies have a high diagnostic value, especially for adenocarcinoma and lymphoma (71.4 and 60%, respectively) [87].The need for histology of GISTs must be thoroughly balanced, since the rate of a positive histological diagnosis by DAE does not exceed 46.7% and the risk of bleeding is not negligible [92,93].…”

Impact of enteroscopy on diagnosis and management of small bowel tumors

“…GISTs are more frequently located in the stomach (50%−60%), small intestine (20%−30%), colon and rectum, peritoneum, esophagus and mesentery (10%) ( 102 ). Endoscopically, they are presented as a protruded subepithelial lesion, sometimes ulcerated, and with dilated vessels ( 103 ).…”

“…Nonetheless, about 80% of the cases in which DAE biopsies missed the diagnosis of SBTs is due to subepithelial lesions. Low positive rates, from 46.7% to 57.4%, besides the high bleeding related risk are the reasons for concerning about the biopsies of a suspected GIST ( 22 , 102 , 105 ). Biopsies should be carefully done at the internal margin of an ulcerated lesion, avoiding the dilated vessels.…”