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Abstract
Backgrounds and study aims
Gastric submucosal tumors (SMTs) are treated or monitored according to gastrointestinal
stromal tumor (GIST) guidelines, but their adequacy has not been thoroughly investigated.
We investigated the long-term course of gastric SMTs to determine the validity of
guideline-based follow-up methods and the factors contributing to their size increase.
Methods
In the study, gastric SMTs diagnosed as gastrointestinal mesenchymal tumors (GIMTs)
by endoscopic ultrasonography (EUS) and followed up with EUS were included. The percentage
and speed of GIMT enlargement and factors associated with the enlargement were investigated
using the Cox proportional hazards model.
Results
From January 1994 to May 2022, 925 gastric SMTs were evaluated with esophagogastroduodenoscopy
(EGD), and 231 SMTs were diagnosed with GIMTs. Of the 231 GIMTs, 145 were examined
by EUS more than twice and were followed up on for more than 6 months. The mean follow-up
period was 5.20 ± 4.04 years (0.5–17.3 years), with 39 of 145 GIMTs (26.9%) increasing
in size with a doubling time of 3.60 ± 3.37 years. A multivariate analysis of factors
influencing tumor growth revealed that irregular extraluminal borders were an increasing
factor (hazard ratio [HR]: 3.65, 95% CI: 1.26–10.52), initial tumor size of 9.5 mm
or less (HR: 0.23, 95% CI: 0.07–0.77) was a non-increasing factor, and GIMTs with
calcification (n = 13) did not increase in size.
Conclusions
Tumor growth in gastric GIMTs less than 9.5 mm in diameter and/or with calcification
is rare. Follow-up intervals for these lesions could be extended.
Acronyms and abbreviations:
SMT (submucosal tumor), GIST (gastrointestinal stromal tumor), GIMT (gastrointestinal mesenchymal tumor), EUS (endoscopic ultrasonography), EGD (esophagogastroduodenoscopy), HR (hazard ratio), NCCN (National Comprehensive Cancer Network), ESMO (European Society for Medical Oncology), DT (doubling time), SD (standard deviation), ROC (Receiver operating characteristic), FNA (fine needle aspiration (FNA)), CT (computed tomography)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 1,
2023
Received in revised form:
December 12,
2022
Received:
September 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
