BACKGROUND: GI stromal tumors (GISTs), with their potential for malignant transformation, are usually treated by surgical intervention. Endoscopic treatment remains controversial. OBJECTIVE: The aim of this study was to investigate clinical outcomes associated with use of endoscopic ligation and resection for diagnosis and treatment of small EUS-suspected gastric GISTs. DESIGN: Prospective case series. SETTING: Academic medical center. PATIENTS: Eight patients with submucosal gastric tumors <2 cm in diameter suspected to be GISTs. INTERVENTIONS: Endoscopic ligation and resection. MAIN OUTCOME MEASUREMENTS: Clinical/technical feasibility, success, and adverse events. RESULTS: Seven patients with small EUS-suspected gastric GISTs were successfully treated by endoscopic ligation, with sloughing of residual tissue within 1 month. All were diagnosed pathologically with GISTs of low malignant potential. One additional patient required a second ligation to remove residual tumor, also diagnosed as a GIST with low malignant potential. No perforation, massive hemorrhage, or other complication requiring endoscopic or surgical intervention occurred. LIMITATIONS: Small number of patients (n = 8) and limited follow-up; risk of microscopically positive margins, which limits application to lesions strongly suspected to be benign. CONCLUSIONS: Endoscopic ligation and resection shows promise as a safe and feasible technique to treat small EUS-suspected gastric GISTs. Controlled clinical trials with more subjects and longer follow-up are needed to confirm the value and limitations of this method. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
BACKGROUND:GI stromal tumors (GISTs), with their potential for malignant transformation, are usually treated by surgical intervention. Endoscopic treatment remains controversial. OBJECTIVE: The aim of this study was to investigate clinical outcomes associated with use of endoscopic ligation and resection for diagnosis and treatment of small EUS-suspected gastric GISTs. DESIGN: Prospective case series. SETTING: Academic medical center. PATIENTS: Eight patients with submucosal gastric tumors <2 cm in diameter suspected to be GISTs. INTERVENTIONS: Endoscopic ligation and resection. MAIN OUTCOME MEASUREMENTS: Clinical/technical feasibility, success, and adverse events. RESULTS: Seven patients with small EUS-suspected gastric GISTs were successfully treated by endoscopic ligation, with sloughing of residual tissue within 1 month. All were diagnosed pathologically with GISTs of low malignant potential. One additional patient required a second ligation to remove residual tumor, also diagnosed as a GIST with low malignant potential. No perforation, massive hemorrhage, or other complication requiring endoscopic or surgical intervention occurred. LIMITATIONS: Small number of patients (n = 8) and limited follow-up; risk of microscopically positive margins, which limits application to lesions strongly suspected to be benign. CONCLUSIONS: Endoscopic ligation and resection shows promise as a safe and feasible technique to treat small EUS-suspected gastric GISTs. Controlled clinical trials with more subjects and longer follow-up are needed to confirm the value and limitations of this method. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.