Endoscopic Evaluation and Management of Gastric Stromal Tumors

Abstract

Purpose of Review Gastrointestinal stromal tumors (GISTs) are both relatively common. Management of these lesions has been challenging with emerging interest in the endoscopic approach for both diagnostic and therapeutic interventions. Recent Findings Although these can be visualized on CT scan, endoscopic ultrasound (EUS) represents the standard method of evaluation and characterization using fine needle aspiration cytology (FNA) when indicated. While EUS-FNA can yield diagnostic cells, full characterization requires a sufficient volume of viable cells to do molecular analysis for c-KIT and determine the mitotic index. A new generation of fine needle biopsy (FNB) needles holds promise for improving our ability to fully characterize these lesions which will hopefully lead to improved management. Very small GISTs (< 1 cm) can probably be ignored, those between 1 and 2 cm are often surveyed, and those > 2 cm should be resected if the patient is fit and the lesion is in an accessible location. Though laparoscopic wedge resection is considered the standard of care, for small GISTs, those that are endophytic and/or located in a difficult position, pure endoscopic or hybrid laparoscopic-endoscopic approaches offer promise. Summary This review highlights the emerging advanced endoscopic approaches to GISTs. Although endoscopic removal of GISTs has two major advantages-precise localization of the lesion and gastric preservation, best practice strategies should focus on available expertise of expert endoscopists.

Endoscopic full-thickness resection for diagnosis of Hirschsprung’s disease

“…full-thickness resection (EFTR) is beneficial for treating a variety of conditions of the lower gastrointestinal tract such as early cancers, polyps, and fistulas [1,2]. Whereas the role of EFTR in the therapy for these conditions has been proven to be effective and safe, there is a paucity of data about its potential utility as a diagnostic intervention in patients with gastrointestinal tract dysmotility disorders [3] In this report, we present a 19-year-old woman with chronic constipation since childhood, which remained severe, despite the use of multiples laxatives, along with dietary and lifestyle changes.…”

A novel technique for endoscope progression in gastroscopy resection: forward-return way for dissection of stromal tumor in the muscularis propria of the gastric fundus

“…Several gastroscopy dissection techniques are used nowadays in clinical practice, including Endoscopic submucosal dissection (ESD) ( 7 ), endoscopic submucosal excavation (ESE) ( 8 ), endoscopic full-thickness resection (EFTR) ( 9 , 10 ), submucosal tunnelling endoscopic resection (STER) ( 11 ), and the combination of EFTR and laparoscopic approach ( 4 , 12 – 15 ). The fundus of the stomach is a challenging area for endoscopic resection of tumors in muscularis propria ( 16 ), especially when using ESD ( 17 ), ESE, or EFTR ( 18 , 19 ).…”

Advancements in the Diagnosis of Gastric Subepithelial Tumors

“…One reason for being hard-to-manage is difficulty in the differential diagnosis of SETs, particularly small lesions. It is considered that SETs that are diagnosed as GIST should be surgically removed as a potential malignant lesion, [5][6][7][8] although there is a slight discordance worldwide according to tumor size, existence of symptoms, and so forth. Therefore, to diagnose whether SETs are GIST is a key to lead the patients to an accurate treatment strategy.…”