Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study
Endoscopic submucosal dissection for gastric gastrointestinal stromal tumors: a retrospective cohort study
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内镜粘膜下剥离术治疗胃胃肠道间质瘤：一项回顾性队列研究。
DOI：
10.1007/s00464-017-5511-3
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发表时间：
2017-11-01
影响因子：
3.1
通讯作者：
Shi, Xin-Gang
中科院分区：
文献类型：
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作者：
An, Wei;Sun, Ping-Bo;Shi, Xin-Gang
背景和目的内镜粘膜下剥离术（ESD）已被用于切除粘膜下肿瘤。然而，关于胃肠道间质瘤（GIST）的潜在恶性行为，ESD是否可以推荐治疗仍存在争议。因此，我们评估了ESD的有效性和安全性，去除胃肠道间质瘤在固有肌层（MP）层，并评估可能的危险因素，胃壁缺损（GWD）。方法168胃肠道间质瘤位于MP层从168例连续患者，基线信息，并发症和治疗结果进行了记录。结果168例胃肠道间质瘤中106例位于胃底，占106%。154例（91.7%）肿瘤形态规则，中位肿瘤大小为1.5（范围0.5-6.0）cm。整块切除率为100%，中位手术时间为46.5（33-181）min。71例患者（42.3%）观察到GWD，2例患者（1.2%）发生迟发性出血，均采用金属夹治疗。共有117例GIST患者处于极低风险，37例患者处于低风险，14例患者处于轻度风险。在中位随访25（6-67）个月期间，未观察到局部复发或远处转移。单因素和多因素Logistic回归分析显示，肿瘤类型是胃肠道间质瘤的独立危险因素（OR值为29.82，95%可信区间为10.87-81.80，P < 0.001）。内镜超声可以帮助评估ESD前的肿瘤类型，这是一个独立的危险因素与ESD后GWD相关。
Background and aim Endoscopic submucosal dissection (ESD) has been used to remove submucosal tumors. However, with regard to the potential malignant behavior of gastrointestinal stromal tumors (GISTs), whether ESD can be recommended for treatment is still controversial. Therefore, we evaluated the efficacy and safety of ESD for removal of GISTs in the muscularis propria (MP) layer and to assess the possible risk factors for a gastric-wall defect (GWD).Methods For 168 GISTs located in the MP layer from 168 consecutive patients, the baseline information, complications, and therapeutic outcomes were recorded. Subsequently, risk factors for a GWD were analyzed.Results Most GISTs (106/168) were located in the fundus of the stomach. Tumor shapes in 154 patients (91.7%) were regular, and the median size of the tumor was 1.5 (range 0.5-6.0) cm. The en bloc resection rate was 100% and the median procedure time was 46.5 (33-181) min. A GWD was observed in 71 patients (42.3%) and delayed bleeding occurred in 2 patients (1.2%), and they were treated by clips. A total of 117 patients with a GIST were at very low risk, 37 patients were at low risk, and 14 patients were at mild risk. No local recurrences or distant metastases were observed during a median follow-up of 25 (6-67) months. Univariate and multivariate logistic regression analyses identified the tumor type to be an independent risk factor for a GWD during ESD (odds ratio 29.82, 95% confidence interval 10.87-81.80, P < 0.001).Conclusion ESD is a safe and feasible method for gastric GISTs, especially for tumor types A and B. Endoscopic ultrasound can aid evaluation of the tumor type before ESD, which is an independent risk factor correlated with a GWD upon ESD.