Outcomes of endoscopic removal of gastrointestinal stromal tumor of the stomach

[Objective] A retrospective study was conducted to determine outcomes of endoscopic resection (ER) procedures (endoscopic muscularis dissection [EMD] and endoscopic full-thickness resection [EFTR]) for gastric GIST(G-GIST).
[Patients and Methods] All patients undergoing ER for G-GIST were identified and data collected retrospectively. Indications for ERs of G-GIST were intraluminal growing type of tumor smaller than 30 mm without ulceration.
[Results] Thirty-two patients underwent ER, including 10 who underwent ESD/EMD and 22 EFTR. The median resecting time was 43 min, and the median time taken endoscopic closure of the resection site with endoclips were 24 min. It was difficult to close the full-layer defect located on the anterior wall side in three patients who underwent EFTR (3/32;9%). These patients underwent laparoscopic hand-sewn closure. Although all tumors were removed without macroscopic residual, pathological evaluations revealed that the rate of microscopic Rx (N=1) /R1 (N=1) resection rate was 6.3%(2/32). During the follow-up period, none of the patients developed tumor recurrence without additional surgery.
[Discussions and Conclusion] Although the choice between ER and laparoscopic surgery should be largely based on tumor/patient characteristics, the present study demonstrated that ERs may be technically feasible, safe, and less invasive options for selected patients with the intraluminal growing type of G-SMT smaller than 30 mm. However, several challenges to overcome still exist in this field.