본문 바로가기
KERD
논문KCI 등재

Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract

2

조회

0

다운로드

2

인용

0

참고문헌

키워드

주제분류내과학

초록

Background/Aims: Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinalstromal tumors (GISTs). However, the effcacy of ET remains debatable. In this study, we evaluated the effcacy and safety of ET forGISTs in the upper gastrointestinal tract. Methods: This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 toJuly 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, andfollow-up were investigated and analyzed. Results: Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the funduswith a mean tumor size of 2.1±1.4 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.3 years, 64.7±35.2 minutes,6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry resultsshowed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence ormetastasis. Conclusions: ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment ofchoice for patients with no metastasis.

Abstract

Background/Aims: Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinalstromal tumors (GISTs). However, the effcacy of ET remains debatable. In this study, we evaluated the effcacy and safety of ET forGISTs in the upper gastrointestinal tract. Methods: This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 toJuly 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, andfollow-up were investigated and analyzed. Results: Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the funduswith a mean tumor size of 2.1±1.4 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.3 years, 64.7±35.2 minutes,6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry resultsshowed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence ormetastasis. Conclusions: ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment ofchoice for patients with no metastasis.

참고문헌 (41)

  1. Nilsson B, "Gastrointestinal stromal tumors : the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era--a population-based study in western Sweden", Cancer, 103, pp.821~829 (2005)
  2. Alvarado-Cabrero I, "Clinicopathologic study of 275 cases of gastrointestinal stromal tumors : the experience at 3 large medical centers in Mexico", Ann Diagn Pathol, 11, pp.39~45 (2007)
  3. Ankit Chhoda, "Contrast Enhanced Harmonic Endoscopic Ultrasound: A Novel Approach for Diagnosis and Management of Gastrointestinal Stromal Tumors", Clinical Endoscopy, 51(3), pp.215~221 (2018), 대한소화기내시경학회
  4. Fletcher CD, "Diagnosis of gastrointestinal stromal tumors : a consensus approach", Int J Surg Pathol, 10, pp.81~89 (2002)
  5. ESMO, "European Sarcoma Network Working Group", Gastrointestinal stromal tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up, 2014, pp.25(Suppl 3), iii21~iii26
  6. Yin X, "Comparison analysis of three different types of minimally invasive procedures for gastrointestinal stromal tumors ≤5cm", J Laparoendosc Adv Surg Tech A, 28, pp.58~64 (2018)
  7. He G, "Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up : a prospective study of 224 cases in a single medical center", Surg Endosc, 30, pp.4206~4213 (2016)
  8. Andalib I, "Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America : methods and feasibility data", Surg Endosc, 32, pp.1787~1792 (2018)
  9. Li J, "Safety and efficacy of endoscopic submucosal dissection of large(≥3 cm)subepithelial tumors located in the cardia", Surg Endosc, 31, pp.5183~5191 (2017)
  10. Kim HH, "Endoscopic treatment for gastrointestinal stromal tumor : advantages and hurdles", World J Gastrointest Endosc, 7, pp.192~205 (2015)
  11. Marcella C, "Clinical overview of GIST and its latest management by endoscopic resection in upper GI : a literature review", Gastroenterol Res Pract, 2018, pp.6864256~ (2018)
  12. Miettinen M, "Gastrointestinal stromal tumors of the stomach : a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up", Am J Surg Pathol, 29, pp.52~68 (2005)
  13. DeMatteo RP, "Two hundred gastrointestinal stromal tumors : recurrence patterns and prognostic factors for survival", Ann Surg, 231, pp.51~58 (2000)
  14. 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)
  15. Nishida T, "Clinical practice guidelines for gastrointestinal stromal tumor(GIST)in Japan : English version", Int J Clin Oncol, 13, pp.416~430 (2008)
  16. Puchalski CM, "Spirituality in the cancer trajectory", Ann Oncol, 23(Suppl 3), pp.49~55 (2012)
  17. Miettinen M, "Gastrointestinal stromal tumors : pathology and prognosis at different sites", Semin Diagn Pathol, 23, pp.70~83 (2006)
  18. Hiki N, "Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection", Surg Endosc, 22, pp.1729~1735 (2008)
  19. Namikawa T, "Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor", World J Gastrointest Endosc, 7, pp.1150~1156 (2015)
  20. He Z, "Endoscopic submucosal dissection of large gastrointestinal stromal tumors in the esophagus and stomach", J Gastroenterol Hepatol, 28, pp.262~267 (2013)
  21. Zhang J, "Clinical applicability of various treatment approaches for upper gastrointestinal submucosal tumors", Gastroenterol Res Pract, 2016, pp.9430652~ (2016)
  22. Chun SY, "Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer : a preliminary analysis of appropriate indications", Surg Endosc, 27, pp.3271~3279 (2013)
  23. Lee CM, "Minimally invasive surgery for submucosal(subepithelial)tumors of the stomach", World J Gastroenterol, 20, pp.13035~13043 (2014)
  24. Chu YY, "Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer", BMC Gastroenterol, 12, pp.124~ (2012)
  25. Zhang Y, "Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer : results from a large study in China", J Clin Gastroenterol, 47, pp.689~694 (2013)
  26. Inoue H, "Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia", Endoscopy, 44, pp.225~230 (2012)
  27. Schmidt A, "Endoscopic full-thickness resection of gastric subepithelial tumors : a single-center series", Endoscopy, 47, pp.154~158 (2015)
  28. Xu MD, "Submucosal tunneling endoscopic resection : a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer(with videos)", Gastrointest Endosc, 75, pp.195~199 (2012)
  29. Lu J, "Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria", Endoscopy, 46, pp.888~892 (2014)
  30. Li QL, "Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer(with video)", Surg Endosc, 29, pp.3640~3646 (2015)
  31. Tan Y, "Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer", Surg Endosc, 31, pp.3376~3382 (2017)
  32. Gong W, "Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors", Endoscopy, 44, pp.231~235 (2012)
  33. Ye LP, "Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer", Surg Endosc, 28, pp.524~530 (2014)
  34. Takashi Tamura, "Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors", Clinical Endoscopy, 52(4), pp.306~313 (2019), 대한소화기내시경학회[DOI]
  35. Kantsevoy SV, "Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization(with videos)", Gastrointest Endosc, 79, pp.503~507 (2014)
  36. Vance RB, "Endoscopic repair of gastric perforation with an over-the-scope clip after endoscopic mucosal resection", Gastrointest Endosc, 80, pp.1205~1206 (2014)
  37. Yahagi N, "New endoscopic suturing method : string clip suturing method", Gastrointest Endosc, 84, pp.1064~1065 (2016)
  38. Nishizawa T, "New endoscopic suturing method : slip knot clip suturing", Gastrointest Endosc, 82, pp.570~571 (2015)
  39. Nishizawa T, "Endoscopic slipknot clip suturing method : an ex vivo feasibility study(with video)", Gastrointest Endosc, 83, pp.447~450 (2016)
  40. Nishizawa T, "Endoscopic slip-knot clip suturing method : prospective pilot study(with video)", Gastrointest Endosc, 85, pp.433~437 (2017)
  41. Akimoto T, ""Hold-and-drag"closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection", Endosc Int Open, 4, pp.E1068~E1072 (2016)

관련 논문AI추천

Clinical Efficacy and Safety of Endoscopic Treatment of Gastrointestinal Stromal Tumors in the Stomach전훈재, Joo Moon Kyung, Kim Seong Min, Kim Won Shik, Lee Beom Jae, Lee Sang Woo, Lee Yeon Ho, Park Jong-Jae, Yoo Ah Young거트앤리버 소화기연관학회협의회 · Gut and Liver2023 · 제17권 제2호Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea정훈용, Do Hoon Kim, Hee Kyong Na, Ho June Song, Jeong Hoon Lee, Ji Yong Ahn, Kee Don Choi, Seokin Kang, Young Soo Park, Yuri Kim대한소화기내시경학회 · Clinical Endoscopy2024 · 제57권 제3호Endoscopic full-thickness resection for the treatment of gastric gastrointestinal stromal tumorsBao-Hui Song, Hon Chi Yip, Jiashaer Bahetinuer, Ming-Yan Cai, Ping-Hong Zhou, Yun-Shi Zhong대한소화기내시경학회 · Clinical Endoscopy2026 · 제59권 제1호Prediction of Risk of Malignancy of Gastrointestinal Stromal Tumors by Endoscopic Ultrasonography강승주, 김미나, 김상균, 김주성, 송인성, 임종필, 정현채거트앤리버 소화기연관학회협의회 · Gut and Liver2013 · 제7권 제6호Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal TumorsAbu Hurairah, Aysha Aslam, Faisal Inayat, Mathew D. Grunwald, Qulsoom Hussain, Shahzad Iqbal대한소화기내시경학회 · Clinical Endoscopy2019 · 제52권 제3호Interpretation of Pathologic Margin after Endoscopic Resection of Gastrointestinal Stromal TumorSang Gyun Kim대한소화기내시경학회 · Clinical Endoscopy2016 · 제49권 제3호

이 간행물의 다른 논문 (20건)