Endoscopic therapy for gastric stromal tumors originating from the muscularis propria

Abstract

Aim: To explore endoscopic therapy methods for gastric stromal tumors originating from the muscularis propria.

Methods: For 69 cases diagnosed as gastric stromal tumors originating from the muscularis propria, three types of endoscopic therapy were selected, based on the size of the tumor. These methods included endoscopic ligation and resection (ELR), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFR). The wound surface and the perforation of the gastric wall were closed with metal clips. Immunohistostaining for CD34, CD117, Dog-1, S-100 and smooth muscle actin (SMA) was performed on the resected tumors.

Results: A total of 38 cases in which the tumor size was less than 1.2 cm were treated with ELR; three cases were complicated by perforation, and the perforations were closed with metal clips. Additionally, 18 cases in which the tumor size was more than 1.5 cm were treated with ESE, and no perforation occurred. Finally, 13 cases in which the tumor size was more than 2.0 cm were treated with EFR; all of the cases were complicated by artificial perforation, and all of the perforations were closed with metal clips. All of the 69 cases recovered with medical treatment, and none required surgical operation. Immunohistostaining demonstrated that among all of the 69 gastric stromal tumors diagnosed by gastroscopy, 12 cases were gastric leiomyomas (SMA-positive), and the other 57 cases were gastric stromal tumors.

Conclusion: Gastric stromal tumors originating from the muscularis propria can be treated successfully with endoscopic techniques, which could replace certain surgical operations and should be considered for further application.

Keywords: Endoscopy; Gastrointestinal stromal tumors; Muscularis propria; Resection; Therapy.

Figure 1

Endoscopic ligation and resection treatment for a gastric stromal tumor less than 1.2 cm in size originating from the muscularis propria. A: Submucosa lesion at the posterior wall of the gastric corpus; B: Endoscopic ultrasound shows that the lesion originates from the muscularis propria; C: COOK ligator aimed at the lesion, ready to ligate; D: The ligated stromal tumor was in the shape of a polypoid with deuto-stem; E: A snare was used to cut the tumor above the rubber band; F: The wound surface was closed with metal clips.

Figure 2

Endoscopic submucosal excavation treatment for a gastric stromal tumor originating from the muscularis propria that is larger than 1.2 cm. A: Submucosa lesion at the gastric corpus; B: Endoscopic ultrasound shows that the lesion originates from the muscularis propria; C: The mucosa of the stromal tumor was cut after submucosal injection; D: Dissection with an IT knife; E: The excavated wound surface, showing that no perforation occurred; F: The resected stromal tumor (4 cm in size).

Figure 3

Endoscopic full-thickness resection treatment for a gastric stromal tumor originating from the muscularis propria larger than 1.2 cm. A: Submucosa lesion at the gastric corpus; B: Endoscopic ultrasound shows that the lesion originates from the muscularis propria; C: Submucosal injection of the mixture of indicarminum, adrenalin and physiological saline; D: Dissection with an IT knife; E: “Artificial” perforation after gastric stromal tumor resection, closed with metal clips; F: Many clips used to close the wound defect; G: The resected tumor without mucosa (5 cm in size); H: The perforation healed 9 d after endoscopic full-thickness resection.