Endoscopic treatment for gastrointestinal stromal tumor：Advantages and hurdles

• 作者: Hyung Hun Kim
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: GASTROINTESTINAL STROMAL TUMOR ENDOSCOPY LAPAROSCOPY EFFICACY Safety
• 年，卷（期）: 2015,（3）
• 页码范围: 192-205
• 页数: 14页
• 分类号: R

摘要

One of the most prominent characteristics ofgastrointestinal stromal tumors （GISTs） is theirunpredictable and variable behavior. GISTs arenot classified as ＂benign＂ or ＂malignant＂ but arerather stratified by their associated clinical risk ofmalignancy as determined by tumor size, location,and number of mitoses identified during surgicalhistology. The difficulty in assessing the malignantpotential and prognoses of GISTs as well as theincreasing incidence of ＂incidental GISTs＂ presentschallenges to gastroenterologists. Recently, endoscopicenucleation has been actively performed as both adiagnostic and therapeutic intervention for GISTs.Endoscopic enucleation has several advantages,including keeping the stomach intact after the removalof GISTs, a relatively short hospital stay, a conscioussedation procedure, relatively low cost, and fewerhuman resources required compared with surgery.However, a low complete resection rate and the risk ofperforation could reduce the overall advantages of thisprocedure. Endoscopic full-thickness resection appearsto achieve a very high R0 resection rate. However, thistechnique absolutely requires a very skilled operator.Moreover, there is a risk of peritoneal seeding dueto large active perforation. Laparoscopy endoscopycollaborations have been applied for more stableand pathologically acceptable management. Thesecollaborative procedures have produced excellentoutcomes. Many procedures have been developed andattempted because they were technically possible.However, we should first consider the theoretical basisfor each technique. Until the efficacy and safety ofsole endoscopic access are proved, the laparoscopyendoscopy collaborative procedure appears to be anappropriate method for minimally destructive GISTsurgery.