Endoscopic submucosal enucleation of small gastric gastrointestinal stromal tumors with cross-shaped incision: report of sixty-nine cases.

Background/aims: Gastric gastrointestinal stromal tumors (gastric GISTs) are the most common gastric submucosal tumors with potential for malignant transformation. Our aim was to assess the efficacy and safety of ESE for gastric GISTs.
Methodology: Small gastric GISTs were dealt with ESE between May 2007 and October 2010.
Results: A total of 69 patients (42 men, 27 women; mean age 47.28±10.10 years) were treated. The mean diameter of the specimens was 1.87±0.57cm (range 0.7-3.0cm). The rates of intra-operative bleeding, delayed bleeding, perforation and surgery related complications were 7.25% (5/69), 1.45% (1/69), 33.33% (23/69) and 5.80% (4/69), respectively. The rate of perforation was 43.2% (19/44) at the fundus of the stomach and 16% (4/25) at the body (p=0.02). The mean time of the procedure was 41.07±10.79 minutes. Nineteen patients with perforation were treated by titanium clips and the rest by laparoscopy. Immunohistochemistry revealed that the positive rates of CD117 and CD34 were 88.41% and 68.12%, respectively. The gastric GISTs were all at low risk. At a mean follow-up period of 17.97±10.75 months (range 1 to 40 months) all of the patients were disease free.
Conclusions: ESE with a cross-shaped incision is possibly a very good choice for small gastric GISTs.