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Submucosal tunnel endoscopic resections (STER) had been increasingly performed for treatment of gastric GIST. One of the limitations for STER is the risk of incomplete tumor resection due to close dissection and bridging of tumor capsule. Endoscopic full thickness resection (EFTR) allowed complete resection of the tumor with margins to prevent recurrence. This study aimed to compare EFTR against STER for treatment of gastric GIST.
We retrospectively reviewed and compare clinical outcomes of patients with gastric GIST who received treatment by either STER or EFTR. Gastric GIST with sizes of less than 4cm were recruited and preoperative investigations including EUS and CT abdomen were performed. The techniques of EFTR and STER were described previously [1,2][Fig 1]. The clinical outcomes including baseline demographics, perioperative and oncological outcomes were compared between two groups.
From 2013 to 2019, 46 patients with gastric GIST were treated by endoscopic resection, 26 received EFTR and 20 received STER (Table 1). There was no difference between two groups in age and gender. Most of the GIST were located at the cardia while EFTR was also applied for resection of GIST at fundus which was not possible for development of submucosal tunnel. There was no difference in the operative time between two groups (94.9 vs 84.9 mins; p = 0.401), while endoscopic suturing was applied more frequently for closure after EFTR (p < 0.0001). Patients after STER had earlier resumption of full diet compared to EFTR, as well as significantly shorter hospital stay while there was no difference in the complication rate between two groups. The en-bloc resection rate for EFTR was significantly higher then STER (100% vs 80%; p = 0.029) while there was no difference in the local recurrence rate between two groups.
This study demonstrated that although patients who received EFTR had longer hospital stay and slower resumption of diet compared to STER, EFTR achieved significantly higher rate of en-bloc resection compared to STER for treatment of gastric GIST.
1. Chiu PW, Yip HC, Teoh AY et al. Surg Endosc. 2019 Apr;33(4):1326-1333.
2. Wong VW, Goto O, Gregersen H, Chiu PW. Curr Treat Options Gastroenterol. 2017 Dec;15(4):603-617.