Endoscopic Resection for Duodenal GISTs Safe, Effective With Senior Endoscopist

Endoscopic resection for duodenal gastrointestinal stromal tumors can be a safe and effective treatment when performed by an experienced endoscopist.

Endoscopic resection is safe and effective for select patients with duodenal gastrointestinal stromal tumors (GISTs) when performed by an experienced endoscopist, according to study findings published in the World Journal of Gastrointestinal Endoscopy.

GISTs are rare, mesenchymal, submucosal tumors that most frequently occur in the stomach (60%), with around 4%-5% occurring in the duodenum. As GISTs grow within the intestinal wall, the difficulty and associated risk for resection increases. Resection becomes difficult when tumors exceed 5 cm in diameter, often necessitating conventional or laparoscopy and endoscopic cooperative surgeries for removal, particularly in intermediate- and high-risk cases.

Researchers conducted a single-center, retrospective study between January 2010 and January 2022, analyzing the efficacy and safety of endoscopic resection in 11 patients with duodenal GISTs that all were 5 cm or smaller in diameter. They focused especially on incidence of perforation, bleeding, complete resection, recurrence, postoperative infection, and distant metastasis during and after endoscopic resection.

The procedure should be performed by a senior endoscopist who has rich experience in the management of complications of endoscopic operations for duodenal lesions.

All 11 patients (100%) experienced complete resection of their duodenal GISTs, with 3 (27.3%) with suspected positive margins and 8 (72.7%) with negative margins.

All 11 patients (100%) also experienced perforation with 100% rate of closure and 1 case (9.1%) with delayed perforation. One patient (9.1%) also experienced delayed bleeding postoperatively.

Slightly more than half (54.5%) of the patients experienced postoperative infections, including septic shock (n=1) and an abscess in the right iliac fossa (n=1).

Patients stayed an average of 15.3 days in the hospital until discharge. After discharge, the follow-up period for all 11 patients ranged from 14 to 80 months. No patient experienced local GIST recurrence or distant metastasis during the follow-up period following endoscopic GIST resection.

“The procedure should be performed by a senior endoscopist who has rich experience in the management of complications of endoscopic operations for duodenal lesions,” the study authors wrote. “If the lesion is difficult to remove endoscopically or there are severe complications that cannot be managed by conservative treatment or an endoscopic method, surgery should be performed in a timely manner.”

Study limitations include the retrospective design, the inclusion of only one center of study, the small sample size due to GIST rarity, lack of randomization or a control group, and the relatively short follow-up period for some included patients.

References:

Wang ZZ, Yan XD, Yang HD, et al. Effectiveness and safety of endoscopic resection for duodenal gastrointestinal stromal tumors: A single center analysis. World J Gastrointest Endosc. 2022;14(11):684-693. doi:10.4253/wjge.v14.i11.684