Endoscopic removal of Gastrointestinal Stromal Tumors (GIST)

Review by Prof. Hany Dabbous (Egypt)

Study Summary 

Gastroenterologists used to refer patients with GIST to surgery. Recently, third space endoscopy is progressively increasing all over the world. Different methods of endoscopic resection of GIST have been proposed namely Endoscopic Full Thickness Resection (EFTR) and Submucosal Tunnel Endoscopic Resection (STER). Philip Wai Yan Chiu and his colleagues from Hong Kong retrospectively reviewed 46 patients with GIST less than 4cm and compared STER with EFTR. Patients who received EFTR had longer hospital stays and slower resumption of diet compared to those who underwent STER. EFTR achieved a significantly higher rate of en-bloc resection compared to STER for treatment of gastric GIST.

Commentary 

Despite being a retrospective study on 46 patients, the study points out to value of endoscopic resection of GIST with included videos and clear illustrations. Current guidelines state that surgical resection should be performed for GIST > 2 cm, while endoscopic surveillance should be conducted for GIST of low risk and < 2 cm. Endoscopic Ultrasound (EUS) helps to detect suspicious GIST and measure its size as well as relation to muscularis propria. Recently, ASGE established guidelines for EFTR and STER, and EFTR is classified into exposed and non-exposed procedures. Exposed EFTR is performed with a tunneled or non-tunneled technique and subsequent closure of the defect, while for non-exposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection. Recent (ESGE) guidelines on management of gastrointestinal subepithelial lesions recommend endoscopic resection as an option for gastric subepithelial lesions < 20 mm.

Citation

Philip Wai Yan Chiu, et al. Endoscopic full-thickness resection (EFTR) compared to submucosal tunnel endoscopic resection (STER) for treatment of gastric gastrointestinal stromal tumors. Endosc Int Open. 2023 Feb; 11(2): E179–E186.

Published online 2023 Feb 23. doi: 10.1055/a-1972-3409

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