Clinical Overview of GIST and Its Latest Management by Endoscopic Resection in Upper GI: A Literature Review (original) (raw)
Related papers
Endoscopy: possibilities and limitations in the management of GIST of the upper GI tract
Romanian journal of internal medicine = Revue roumaine de médecine interne
Gastrointestinal stromal tumors (GISTs) have been a topic of increasing interest since the discovery of their cellular activation pathway via the receptor for tyrosine kinase (KIT) leading to the possibility of targeted molecular therapy in the form of imatinib mesylate. Endoscopic diagnostic and therapeutic possibilities have also been developing at a rapid pace in recent years. Endoscopic ultrasonography (EUS) allows for an accurate assessment of submucosal tumors and can provide tissue samples for diagnostic purposes using fine needle aspiration techniques. Several newer endoscopic techniques, including contrast enhanced EUS and endoscopic submucosal dissection, have also proven useful in the management of GISTs. Although the many recent studies have focused on the role of endoscopy in diagnosing and treating GISTs, we still need better evidence in order to formulate accurate guidelines.
Surgical Treatment of Gastrointestinal Stromal Tumors (GISTs)
InTech eBooks, 2012
However, when esophagogastric or duodenal subepithelial nodules with < 2 cm diameter are detected, the standard procedure consists in endoscopic ultrasound (EUS) assessment and active surveillance of the individual patient, because many of these small nodules, when they correspond to GISTs, are tumors of low biological risk (Fletcher, Berman et al. 2002; Miettinen and Lasota 2006) or whose clinical behavior remains to be clarified. Surgery is reserved for patients whose tumor increases in dimension or is symptomatic. The results of a recent retrospective analysis (Lok, Lai et al. 2009) indicate that only some (3 out of 23; 13.0%) of the small tumors without high-risk EUS characteristics (large dimension, irregular extraluminal limits, heterogeneous echo pattern, presence of cystic areas, and hyperechoic foci) progressed during the long-term follow-up with EUS. As an alternative, the decision can be shared in an individual base with the patient, either to opt for an initial histological evaluation (needle biopsy) or for the tumor excision, when the morbidity is not substantial. On the other hand, when facing intra-abdominal nodules without endoscopic evaluation, the laparoscopy/laparotomy resection is the standard approach. Also for rectal nodules (or in the recto-vaginal space), the best management must be the accomplishment of biopsy/resection, after EUS evaluation, regardless of the tumor dimension, because GISTs in this location display high biological risk, and the local implications of a surgical intervention in this region is more critical, mostly in tumors of great dimensions. The guidelines of the ESMO and the NCCN coincide in the recommendation that tumors with dimension > 2 cm must be resected (Casali and Blay 2010; Demetri, von Mehren et al. 2010), because being GISTs, they imply a higher risk of aggressive behavior. For patients with localized primary GIST, the surgical resection continues to be the only possibility of cure of their illness. In our experience we obtained complete macroscopic resection (R0 or R1) in 92.3% of GISTs and microscopic negative margins (R0) in 75% of cases. 5-year disease-specific survival (DSS) and recurrence-free survival (RFS) was 87.7% and 89.8%, respectively, after surgical resection of patient's primary GIST. The recurrence rate was significantly (p=0.045) lower in R0 cases. In the multivariate analysis, only the presence of macroscopic residual tumor (R2) was significantly associated (p=0.013) with shorter DSS (Gouveia, Pimenta et al. 2008). The DSS and RFS values in our patients fit with results published in other studies (
Endogastric resection of gastrointestinal stromal tumor
Journal of Visualized Surgery, 2016
Gastric gastrointestinal stromal tumors (GIST) have a distinct surgical therapy compared to gastric adenocarcinoma. Large oncologic margins and lymphadenectomy are not necessary rendering local resections suitable to treat the disease and spare the stomach. That may be accomplished through a minimally invasive approach. We present a case of a 67-year-old woman with an endophytic 3.5 cm gastric GIST located in the posterior wall of the gastric body that underwent an endogastric resection. Operation was uneventful. The patient was discharged in the following day. Pathologic examination showed free margins and a low grade GIST. Endogastric resection is a feasible option in endophytic GISTs located in the posterior wall of the stomach.
Endoscopic ligation and resection for the treatment of small EUS-suspected gastric GI stromal tumors
Gastrointestinal Endoscopy, 2010
Background: GI stromal tumors (GISTs), with their potential for malignant transformation, are usually treated by surgical intervention. Endoscopic treatment remains controversial. Objective: The aim of this study was to investigate clinical outcomes associated with use of endoscopic ligation and resection for diagnosis and treatment of small EUS-suspected gastric GISTs. Design: Prospective case series. Setting: Academic medical center. Patients: Eight patients with submucosal gastric tumors Ͻ2 cm in diameter suspected to be GISTs. Interventions: Endoscopic ligation and resection. Main Outcome Measurements: Clinical/technical feasibility, success, and adverse events. Results: Seven patients with small EUS-suspected gastric GISTs were successfully treated by endoscopic ligation, with sloughing of residual tissue within 1 month. All were diagnosed pathologically with GISTs of low malignant potential. One additional patient required a second ligation to remove residual tumor, also diagnosed as a GIST with low malignant potential. No perforation, massive hemorrhage, or other complication requiring endoscopic or surgical intervention occurred. Limitations: Small number of patients (n ϭ 8) and limited follow-up; risk of microscopically positive margins, which limits application to lesions strongly suspected to be benign. Conclusions: Endoscopic ligation and resection shows promise as a safe and feasible technique to treat small EUS-suspected gastric GISTs. Controlled clinical trials with more subjects and longer follow-up are needed to confirm the value and limitations of this method. GI stromal tumors (GISTs) are common submucosal tumors of the stomach with the potential for malignant transformation, which are usually treated surgically. 1-3 Asymptomatic GISTs Ͻ2 cm in diameter are considered to be of low malignant potential; however, the management of these small GISTs remains uncertain. Small lesions may gradually grow, produce symptoms, and undergo malignant transformation. 4-6 Moreover, the presence of a GIST, which necessitates lifelong follow-up, can be a source of psychologic stress. An endoscopic approach is less invasive than open surgical or laparoscopic interventions; however, endoscopic treatment of GISTs has not been well established. 7,8 A minimally invasive technique that can diagnose and remove small GISTs with a low incidence of procedure-related complications would be a useful new option for physicians and patients. Here, we report development of a new method of combined endoscopic ligation and resection that shows promise for the diagnosis and treatment of patients with small EUS-suspected gastric GISTs. The aim of this study was to prospectively evaluate both the feasibility and the safety of the method. PATIENTS AND METHODS Patients A total of 8 patients (2 men, 6 women; median age, 54 years; range, 45-71 years) who were scheduled to undergo Abbreviations: GIST, GI stromal tumor.
An audit of surgical management of gastrointestinal stromal tumours (GIST)
European Journal of Surgical Oncology (EJSO), 2006
Aim: To analyze GIST outcome after primary resection and to determine if a new grading system could adequately predict there prognosis. Methods: A retrospective review (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) identified 80 patients who underwent primary surgical resection for, c-KIT positive, GIST. Follow-up was complete for all patients (median follow-up 42, range 1-132, months). GIST were classified as low or high grade according to the following parameters: size, mitotic rate, mitotic index (MiB1), presence of necrosis, invasion of adjacent structure and presence of metastasis. Results: GIST originated from the stomach (46), small bowel (30), colon and rectum two and mesentery two. At surgery, 94% of cases presented with localized disease and 6% blood born metastasis with or without lymph node invasion. Resections were complete (R0) in 72 cases. R0 resection correlated with prognosis (p!0.01). Sixty GIST were classified as low grade (median follow-up 60 months) and 20 as high grade (median follow-up 27 months). Five-year actuarial survival of patients with low or high grade GIST were of 95 and 21%, respectively, (p!0.001). Conclusion: Prognosis of GIST after surgical treatment is influenced by completeness of primary resection and tumour malignant potential. Low grade GIST have an excellent prognosis after surgery alone, while high grade GIST have a high rate of recurrence after primary resection. Adjuvant treatment should be advocated for patient with either high grade GIST or after incomplete primary resection. The presented grading system can reliably predict GIST outcome after primary surgical treatment.
Oncology Letters, 2014
Gastrointestinal stromal tumors (GISTs) are rare, but remain the most common GI mesenchymal neoplasms. In the present study, six cases of GIST are reported, and one of these cases, a patient with esophageal GIST, is reported in-depth. Certain recent developments in the clinical therapy of GISTs are also discussed. The records of all surgically-resected GI stromal tumors treated at the Al-Hada Military Hospital between January 2007 and December 2012 were reviewed. There were six cases of surgically resected GISTs during this time period, three males and three females, with a mean age of 69.3±16.4 years. The stomach was involved in 66.7% of cases, the small intestine in 16.7% and the esophagus, which is an extremely rare site, in 16.7% of cases. The most common symptom at presentation was abdominal pain, followed by GI bleeding. The mean tumor size was 8.7±6.3 cm. Surgery was indicated by the presence of the aforementioned symptoms or a tumor size >5 cm. All tumors were completely resected with histologically negative margins. The diagnoses were established by immunohistochemistry. Four patients were classified as possessing a high-grade variant, and were administered with tyrosine kinase inhibitors (TKIs). Following a mean follow up of 31 months, no recurrence or mortality was detected. Complete surgical resection with tumor-free margins is the standard treatment for GISTs, and TKIs should be used as adjuvant therapy if the risk of progressive disease is high.
Gastrointestinal stromal tumor (GIST)'s surgical treatment, NCI experience
Journal of the Egyptian National Cancer Institute, 2005
To review the clinical presentation, surgical management, and prognostic factors for gastrointestinal stromal tumors. A prospective study which was carried out between January 2002 and March 2004 on thirty-three patients with gastrointestinal stromal tumor (GIST) at the National Cancer Institute, Cairo University. All patients were evaluated preoperatively and underwent exploratory laparotomy with a curative intent, they were followed up for period ranging between 14-35 months. Among the 33 patients there were 17 males and 16 females. The mean age of patients was 52.8 years. Clinical findings included gastrointestinal bleeding (42.4%), palpable mass (33.3%) and abdominal pain (24.3%). The stomach was the most common site of origin of the disease (39.4%), followed by the colorectal region (24.2%). Tumors were high grade in 63.6% of patients and low-grade in 36.4% of patients. Complete resection of all gross disease was accomplished in 26 patients (78.7%), among whom, multiple adjacen...
Surgical Therapy for Gastrointestinal Stromal Tumours of the Upper Gastrointestinal Tract
Journal of Gastrointestinal Surgery, 2009
This study aimed to examine clinicopathological features and outcomes after primary resection of gastrointestinal stromal tumours (GIST) of the upper gastrointestinal tract Fifty consecutive patients were identified as having a mesenchymal tumour of the upper gastrointestinal tract resected at our institution, of which 47 were GISTs. The influence of clinicopathological variables on disease-free survival was evaluated using Kaplan-Meier estimates and Cox hazard model. The median age was 62.8 (21.3-94.7). The commonest presenting symptoms were anaemia (43%) and pain (34%). Tumours were located in the stomach (64%), small bowel (34%) and oesophagus (2%). Median follow-up was 20.4 (2-106) months. Fletcher low/intermediate-risk tumours had a significantly better (p = 0.0008) 2- and 5-year actuarial survival of 100% compared with 88% and 58% for high-risk group. Recurrence-free survival at 2 and 5 years was 100% for low/intermediate-risk group compared with 68% and 45% for the high-risk group (p = 0.0008). Univariate analysis of predictors of recurrence identified male sex, high mitotic rate and tumour size as significant. Multivariate analysis showed high mitotic rate as the only poor prognosticator (Hazard ratio = 16.7, p = 0.02). Surgical excision of low- and intermediate-grade GIST has an excellent prognosis. Surgery remains the mainstay of treatments, and high-grade tumours carry a significantly worse prognosis. High mitotic rates are an independent poor prognosticator.