Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule Endoscopy—A Case Report and Literature Review

Ling, Jie; Lamsen, Marie; Coron, Roger; Deliana, Danila; Siddiqui, Sabah; Rangraj, Madhu; Jesmajian, Stephen

doi:10.1155/2013/285457

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…In patients presenting with signs of chronic gastrointestinal hemorrhage, upper and lower gastrointestinal endoscopy are usually the initial diagnostic steps. However, small intestinal GISTs may not be amenable to standard endoscopic examination, and advanced endoscopic techniques (double-balloon enteroscopy and/or capsule endoscopy) may be required in these cases [20,21,22,23]. For treatment planning purposes, endoscopic assessment of GISTs should be complemented by cross-sectional imaging in all patients.…”

Section: Diagnosismentioning

confidence: 99%

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Garlipp

Bruns

2014

Gastrointest Tumors

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Background: Gastrointestinal stromal tumors (GISTs) are the most frequently diagnosed mesenchymal neoplasms of the gastrointestinal tract. Despite their biological and clinical heterogeneity, the majority of these tumors are positive for the receptor tyrosine kinase KIT and are driven by KIT- or platelet-derived growth factor receptor alpha (PDGFRA)-activating mutations. There are still uncertainties regarding their clinical and molecular characterization and the optimal treatment regimens, making it difficult to establish a universal treatment algorithm for these tumors. Summary: From a clinical perspective, the main difference between GISTs and other gastrointestinal neoplasms is that the benign or malignant behavior of GISTs cannot be predicted from histopathology, but instead relies on empirically established scoring systems. Clinical data suggest that malignant potential may be an inherent quality of some GISTs rather than a feature acquired by the tumor during disease progression. Thus, some patients may require prolonged anti-tumor treatment even after complete surgical removal of the tumor. Key Message: Although GISTs are the most frequently occurring mesenchymal neoplasms in the gastrointestinal tract, no universal treatment algorithms exist. This paper reviews the current evidence that guides the management of GISTs. Practical Implications: The management of localized GISTs involves the use of surgical resection, with the inclusion of preoperative tyrosine kinase inhibitor treatment for locally advanced, primarily unresectable tumors and for resectable cases requiring extensive surgery. Imatinib is also indicated as adjuvant therapy after complete surgical removal of GISTs with a high estimated risk of recurrence unless specific mutations conferring imatinib resistance are present. The optimal duration of adjuvant treatment is still controversial. For patients with metastatic imatinib-sensitive GISTs, imatinib constitutes the first-line standard treatment. Molecular characterization of the tumor (with respect to the PDGFRA and KIT genes) is mandatory prior to imatinib therapy. Sunitinib and regorafenib are established as alternative treatments for patients demonstrating generalized disease progression on imatinib. New tyrosine kinase inhibitors such as ponatinib and crenolanib as well as drugs targeting alternative pathways are currently under investigation. Surgery and locally ablative treatments may be indicated in some metastatic patients.

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Section: Diagnosismentioning

confidence: 99%

State of the Art in the Treatment of Gastrointestinal Stromal Tumors

Garlipp

Bruns

2014

Gastrointest Tumors

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“…If bleeding is intraperitoneal, patients may present as an acute abdomen whereas hemorrhage into the lumen may present more chronically with hematemesis, melena, or anemia [1]. Anemia is present in ~50% of patients with GIST [36]. Bleeding is more common as a clinical presentation in duodenal GISTs (75%) compared with gastric (54%) or ileojejunal (28%) [37].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Video capsule endoscope (VCE) and double balloon enteroscopy (DBE) have both been used successfully in the detection of GISTs, with detection rates of 80% and 60% respectively [36].…”

Section: Miscellaneousmentioning

confidence: 99%

Gastrointestinal Stromal Tumors in the 21<sup>st</sup> Century

Kanthan¹,

Senger²,

Ahmed³

et al. 2014

JCT

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Gastrointestinal stromal tumours (GISTs) are rare mesenchymal lesions accounting for only 0.2% of all gastrointestinal neoplasms. These tumors arise from the interstitial cells of Cajal, with mutations described in proto-oncogenes such as KIT, PDGFRA, DOG-1, and SDH. The majority of these lesions are asymptomatic, thus the true incidence remains unknown. While patients typically undergo initial endoscopy, CT scan and/or MRI, findings are often nonspecific and require a biopsy to identify the tumor. As such, immunohistochemical evaluation is the gold-standard for the accurate diagnosis of GIST. Though surgical excision remains the gold-standard for curative management, the discovery of imatinib, a tyrosine kinase inhibitor (TKI), has revolutionized the treatment of GIST in the 21 st century as a "prototype" of molecular targeted therapy for solid tumors. Risk assessment for recurrence divides these tumors into low and high-risk categories. In the latter, a role for adjuvant therapy with TKI confers a significantly better prognosis than previously observed. However, secondary mutations conferring drug resistance remain an ongoing challenge for management, as few alternative treatment options are available for patients intolerant/refractory to TKI therapy. In this review, we summarize the epidemiology, molecular pathogenesis, clinical presentation, diagnosis, pathology features, management options, and prognostic features of GISTs.

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