Objective: To assess the efficacy and safety of endoscopic submucosal excavation(ESE) for gastric gastrointestinal stromal tumors(GISTs).
Methods: Clinical data of 86 gastric GISTs patients undergoing ESE in our department from January 2007 to January 2013 were analyzed retrospectively. The whole tumor biopsy was used to determine the risk stratification. Complication of ESE was recorded and recurrence was investigated during regular follow-up.
Results: Tumors of all 86 cases were resected completely without residue proved by postoperative pathology. According to NIH risk stratification, 12 cases were very low risk, 30 low risk, 25 moderate risk, and 19 high risk. Tumor size, tumor depth, and tumor surface bleeding or edema were associated with the risk stratification of the GISTs(all P<0.05). Bleeding rate of ESE was 5.8%(5/86), including severe intraoperative bleeding in 1 case, postoperative delayed bleeding in 4 cases. The maximal tumor diameter was <2 cm in 1 case and >2 cm in 4 cases. The tumor were grade as moderate risk in 3 cases and high risk in 2 cases. The perforation rate was 10.5%(9/86), including tumors with a maximal diameter of <2 cm in 4 cases and >2 cm in 5 cases. The tumors were grade as moderate risk in 5 cases and high risk in 4 cases. Recurrence rate was 5.8%(5/86), including tumors with a maximal diameter <2 cm in 2 case and >2 cm in 3 cases. The tumors were grade as moderate risk in 4 cases and high risk in 1 cases.
Conclusion: ESE is safe and effective for the treatment of gastric GISTs. The operative complication and postoperative recurrence may be associated with the tumor risk stratification.