Strategy of treatment of submucosal gastric tumors.
BACKGROUND
The more frequent use of endoscopic ultrasonography (EUS) leads to an increased number of diagnosed gastric submucosal tumors (G-SMT). Since until now rather little therapeutical success in respect of these tumors has been achieved, we evaluated our concept of watchful waiting and selective treatment of patients with G-SMT in an analysis of prospectively collected data.


METHODS
Forty-seven consecutive patients with G-SMT treated at our institution between 1994 and 2000, were included. All patients underwent abdominal ultrasound and EUS, and in case of suspicious findings or a tumor size > 2 cm EUS fine needle aspiration (EUS-FNA) was performed. Patients were operated on if a malignant tumor was suspected (tumor size > 2 cm; detection of metastases) or if complications occurred (e.g. bleeding, ulceration).


RESULTS
All 47 patients were included in this study. Typical symptoms were nausea (64%), bleeding (11%) and pain (9%). EUS showed a G-SMT averaging 6.4 (0.8 - 30) cm in size. EUS-FNA was performed in 24 patients revealing PAP III (n = 1), PAP II (n = 21) and PAP I (n = 2) scores. Surgery was performed in 33 patients, revealing gastrointestinal stromal tumors (GISTs) in 18 patients as well as several other malignant and non-malignant lesions. During follow-up (median 37 months), none of the conservatively treated patients (n = 14) developed a malignant tumor.


CONCLUSIONS
In one third of our patients surgery could be avoided with this strategy. No delayed diagnosis of a malignant tumor during follow-up was established. Small G-GMT's should be monitored conservatively if diagnostic procedures and follow-up was performed by EUS and eventually EUS-FNA.
Sato
T
T
Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Düsseldorf der Heinrich-Heine-Universität, Moorenstr. 5, D-40225 Düsseldorf, Germany.
Peiper
Matthias
M
Fritscher-Ravens
A
A
Gocht
A
A
Soehendra
N
N
Knoefel
W T
WT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome