Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea
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Background/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. Methods: Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. Results: Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group. Conclusions: cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.
Abstract
Background/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. Methods: Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. Results: Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group. Conclusions: cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.
참고문헌 (27)
- Deprez PH, "Endoscopic management of subepithelial lesions including neuroendocrine neoplasms : European Society of Gastrointestinal Endoscopy(ESGE)Guideline", Endoscopy, 54, pp.412~429 (2022)
- Lu J, "Endoscopic management of upper gastrointestinal submucosal tumors arising from muscularis propria", J Clin Gastroenterol, 48, pp.667~673 (2014)
- Cho JW, "Current guidelines in the management of upper gastrointestinal subepithelial tumors", Clin Endosc, 49, pp.235~240 (2016)
- Yang Z, "A multivariate prediction model for high malignancy potential gastric GI stromal tumors before endoscopic resection", Gastrointest Endosc, 91, pp.813~822 (2020)
- Parab TM, "Gastrointestinal stromal tumors : a comprehensive review", J Gastrointest Oncol, 10, pp.144~154 (2019)
- Ko WJ, "Current techniques for treating gastrointestinal stromal tumors in the upper gastrointestinal tract", Clin Endosc, 49, pp.226~228 (2016)
- Schmieder M, "Comparison of different risk classification systems in 558 patients with gastrointestinal stromal tumors after R0-resection", Front Pharmacol, 7, pp.504~ (2016)
- Demetri GD, "NCCN Task Force report : update on the management of patients with gastrointestinal stromal tumors", J Natl Compr Canc Netw, 8(Suppl 2), pp.S1~S41 (2010)
- Kim GH, "Comparison of the treatment outcomes of endoscopic and surgical resection of GI stromal tumors in the stomach : a propensity score-matched case-control study", Gastrointest Endosc, 91, pp.527~536 (2020)
- Joensuu H, "Risk stratification of patients diagnosed with gastrointestinal stromal tumor", Hum Pathol, 39, pp.1411~1419 (2008)
- Chak A, "Endosonographic differentiation of benign and malignant stromal cell tumors", Gastrointest Endosc, 45, pp.468~473 (1997)
- Palazzo L, "Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours", Gut, 46, pp.88~92 (2000)
- Joo MK, "Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract", Gastrointest Endosc, 83, pp.318~326 (2016)
- McCarter MD, "Microscopically positive margins for primary gastrointestinal stromal tumors : analysis of risk factors and tumor recurrence", J Am Coll Surg, 215, pp.53~60 (2012)
- Zhu Y, "Microscopic positive tumor margin does not increase the rate of recurrence in endoscopic resected gastric mesenchymal tumors compared to negative tumor margin", Surg Endosc, 34, pp.159~169 (2020)
- Chapman BC, "Postoperative pneumoperitoneum : is it normal or pathologic?", J Surg Res, 197, pp.107~111 (2015)
- Li QL, "Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer : a large study of endoscopic submucosal dissection(with video)", Gastrointest Endosc, 75, pp.1153~1158 (2012)
- An W, "Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors : a retrospective cohort study", Surg Endosc, 31, pp.4522~4531 (2017)
- Białek A, "Endoscopic submucosal dissection for treatment of gastric subepithelial tumors(with video)", Gastrointest Endosc, 75, pp.276~286 (2012)
- Tan Y, "Endoscopic resection of gastric gastrointestinal stromal tumors", Transl Gastroenterol Hepatol, 2, pp.115~ (2017)
- Huberty V, "Endoscopic full-thickness resection of a gastric GI stromal tumor", VideoGIE, 4, pp.120~122 (2019)
- Guo JT, "Endoscopic full-thickness resection using an over-the-scope device : a prospective study", World J Gastroenterol, 27, pp.725~736 (2021)
- Schlag C, "EndoResect study : endoscopic full-thickness resection of gastric subepithelial tumors", Endoscopy, 45, pp.4~11 (2013)
- Meier B, "Endoscopic full-thickness resection of gastric subepithelial tumors with the gFTRD-system : a prospective pilot study(RESET trial)", Surg Endosc, 34, pp.853~860 (2020)
- Schmidt A, "Endoscopic full-thickness resection of gastric subepithelial tumors : a single-center series", Endoscopy, 47, pp.154~158 (2015)
- Inoue H, "Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia", Endoscopy, 44, pp.225~230 (2012)
- Lv XH, "Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors : a systematic review and meta-analysis", Surg Endosc, 31, pp.49~63 (2017)