Endoscopic ligation and resection for the treatment of small EUS-suspected gastric GI stromal tumors

Abstract

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 <2 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 = 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.