Endoscopic mucosal resection with a ligator device for the treatment of upper gastrointestinal stromal tumors

Abstract:

Objective：To evaluate the clinical efficacy，safety，and technical feasibility of endoscopic mucosal resection with ligator device（EMR-L） for gastrointestinal stromal tumors（GISTs） of upper gastrointestinal tract. Methods：This is a retrospective medical record review，which includes fifty-three consecutive patients，who underwent EMR-L for GISTs in upper GI tract from May，2007，to May，2011. Our EMR-L includes four steps as suction，ligation，snare and closure，which has two improvements compared with conven－tional EMR-L. One is ligating two elastic bands，and the other is fixing two clips before snare. The outcome measures included：base－line patient characteristics，endoscopic outcomes，procedural complications，pathological outcomes，and follow-up outcomes. Results：A total of 53 patients were eligible for inclusions in the study，the mean age being 51.7（range 22~76）years，the male/female ratio be－ing 1∶2.3（16∶37）. The tumors were all protruding lesions with hemisphere or strip shape，and the mean lesion size under EUS was 0.95（range 0.3~2.5） cm. EMR-L was easily and successfully performed in 51 patients（success rate，96.2%），but failed in 2 patients who turned to surgery treatment. The mean procedure time was 25（range，14~56） minutes.Serious complications included gastric per－foration 7.5%（4 of 53）；mild complications included retrosternal discomfort 9.4%（5 of 53） and abdominal discomfort 9.4%（5 of 53）. The postoperative histological diagnosis was GISTs for all cases，37.7%（23 of 53） in esophagus and 62.3%（30 of 53） in stomach. Dur－ing a mean follow-up period of 13.5 months（range，3~43 months），there was only one recurrence observed 12 months postoperatively with the recurrence rate of 1.9%. Conclusion：EMR-L is an effective，safe and feasible endoscopic modality for the treatment of small （≤2.5 cm） upper GISTs.