Endoscopic full-thickness resection of gastric gastrointestinal stromal tumor: a Japanese case series

Satoki Shichijo; Noriya Uedo; Yoshitomo Yanagimoto; Kazuyoshi Yamamoto; Mitsuhiro Kono; Hiromu Fukuda; Yusaku Shimamoto; Kentaro Nakagawa; Masayasu Ohmori; Masamichi Arao; Taro Iwatsubo; Hiroyoshi Iwagami; Kenshi Matsuno; Shuntaro Inoue; Noriko Matsuura; Hiroko Nakahira; Akira Maekawa; Takashi Kanesaka; Yoji Takeuchi; Koji Higashino; Takeshi Ohmori; Ryu Ishihara

Authors Satoki Shichijo, Noriya Uedo, Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Kenshi Matsuno, Shuntaro Inoue, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Takeshi Ohmori, Ryu Ishihara.

Abstract

Background Gastrointestinal stromal tumors (GISTs) are potentially malignant and are indicated for resection. The standard treatment for resectable GISTs is surgery, although endoscopic resection has been reported outside Japan. This study retrospectively analyzed the results of endoscopic resection of GISTs in Japan.

Method We identified patients with GISTs treated only by endoscopic resection in our institute between January 2016 and December 2018, and analyzed their clinical and pathological characteristics.

Results During the study period, 8 GISTs were resected only by endoscopy: 7 were located in the upper third of the stomach and 1 in the middle. All were intraluminal growth type. Median (range) tumor diameter was 20 (10-35) mm. All tumors were resected en bloc with a median (range) operation time of 67.5 (50-166) min. Complete perforation occurred in 5 cases, but the serosa remained in 2 and the outer layer of the muscularis propria remained in 1. The defect was endoscopically closed with clip-and-endoloop purse-string suturing (n=3), simple endoclipping (n=2), or over-the-scope clipping (n=2), and 1 did not require closure because the outer longitudinal muscle was preserved. Oral feeding was commenced on postoperative day (POD) 3 (median; range 2-4), and the patient was discharged on POD 6 (median; range 4-11). No serious adverse event developed after the procedures.

Conclusion Endoscopic resection for selected cases of small intraluminal GISTs is feasible, making it a viable alternative treatment option to laparoscopic surgery.

Keywords Endoscopic resection, endoscopic submucosal dissection, gastrointestinal stromal tumor, endoscopic full-thickness resection

Ann Gastroenterol 2019; 32 (6): 593-599