Endoscopic band ligation of small gastric stromal tumors and follow-up by endoscopic ultrasonography.
BACKGROUND
Gastrointestinal stromal tumor (GIST) is a relatively common gastric submucosal tumor with potential for malignant transformation. The efficacy of a new method for resection of these tumors, endoscopic band ligation, was evaluated.


METHODS
The study included 29 patients with small gastric stromal tumors arising in the gastric muscularis propria as determined by endoscopy, endoscopic ultrasonography (EUS), and deep endoscopic biopsies. A standard endoscope with a transparent cap attached to the tip was used. The cap was placed over the lesion, maximum sustained suction was applied, and an elastic band was released around the base. Beginning two weeks after banding, the lesions were observed endoscopically once per week until healing was complete. Thereafter, all patients underwent EUS every two to three months on schedule.


RESULTS
The 28 GISTs sloughed completely. The mean time required for complete healing after band ligation was 4.8 weeks. One lesion did not slough because they were not completely ligated. The lesion was ligated for the second time and sloughed completely. Bleeding occurred in one patient three days after ligation because the lesion sloughed early. The bleeding was managed successfully with metallic clips. No perforation and other complications occurred. Followup ranged from 36 to 51 months, during which time only one recurrence was observed four months postoperatively.


CONCLUSIONS
Endoscopic band ligation with systematic followup by EUS is an effective and safe treatment for small GISTs.
Sun
Siyu
S
Endoscopy Center, The Second Hospital, China Medical University, Sanhao Street 36, Shenyang, Liaoning Province, 110004, China. Sunsy@cmu2h.com
Ge
Nan
N
Wang
Caixia
C
Wang
Mengchun
M
Lü
Qingjie
Q
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome