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Efficacy and safety of endoscopic submucosal dissection for large gastric stromal tumors - 29/01/20

Doi : 10.1016/j.clinre.2019.03.004 
Qiaofeng Chen, Mingju Yu, Yupeng Lei, Chang Zhong, Zhijian Liu, Xiaojiang Zhou, Guohua Li, Xiaodong Zhou , Youxiang Chen
 Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China 

Corresponding author.

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Highlights

Few studies has assessed the therapeutic efficacy and safety of endoscopic submucosal resection on large (≥ 3 cm) gastric stromal tumors.
Here it is shown that endoscopic submucosal dissection is a feasible, safe, effective and minimally invasive approach for the resection of large gastric stromal tumors.
Tumors originating from the deep muscularis propria layer, located at the fundus and with an irregular shape were identified as risk factors for the occurrence of complications.

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Summary

Background and aim

Endoscopic submucosal dissection (ESD) of gastric stromal tumors is becoming increasingly common. However, there have been few studies analyzing the therapeutic efficacy and safety of this technique on large (≥ 3 cm) gastric stromal tumors (LGSTs). The aim of this study was to determine the feasibility of ESD for the removal of LGSTs and to investigate the clinical safety and efficacy of ESD for this indication.

Methods

A retrospective analysis was carried out on 82 patients with LGSTs who underwent an ESD. Data on therapeutic outcomes and follow-up were collected for an analysis of the rates of en block resection and complete resection. A logistic regression model was used to identify potential risk factors for ESD-related complications, and a receiver operating characteristic (ROC) curve was generated for qualifying independent risk factors.

Results

En bloc resection was achieved in 81 lesions (98.8%), and complete resection was achieved in 80 lesions (97.6%). The rates of intraoperative and postoperative bleeding were 6.1% and 3.7%, respectively. The accidental perforation rate was 12.2%, the postoperative perforation rate was 3.7%, the intentional perforation rate was 28.0%, and the postoperative infection rate was 12.2%. There was no postoperative mortality. LGSTs originating from the deep muscularis propria (MP) layer (OR = 4.905, 95% CI: 1.362–17.658, P = 0.015), located at the gastric fundus (OR = 4.927, 95% CI:1.308–18.558, P = 0.018) and with an irregular shape (OR = 4.842, 95% CI: 1.242–18.870, P = 0.023) increased the rate of complications. The prediction model that incorporated these factors demonstrated an area under the ROC curve of 0.77 (95% CI: 0.66–0.89). No tumor recurrence or distant metastasis was observed during the follow-up period, which ranged from 6–36 months.

Conclusions

ESD is a feasible, safe, effective and minimally invasive approach for the resection of LGSTs. Tumors originating from the deep MP layer, located at the fundus and with an irregular shape were identified as risk factors for the development of complications.

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Keywords : Complications, Efficacy, Endoscopic submucosal dissection, Large gastric stromal tumor


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Vol 44 - N° 1

P. 90-100 - février 2020 Retour au numéro
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