title: Endoscopic submucosal dissection of large gastrointestinal stromal tumors in the esophagus and stomach.
abstract: OBJECTIVE
  Gastrointestinal stromal tumors (GISTs), the most common mesenchymal tumors of the digestive tract with potential for malignant transformation, are mainly treated by open surgery or laparoscopic resection. The aim of this retrospective study was to evaluate the clinical efficacy, safety, and feasibility of endoscopic submucosal dissection (ESD) for large-size (2-5 cm) GISTs in the esophagus and stomach.
  
  
  METHODS
  A total of 31 patients with large-size GISTs in the esophagus (6 patients) and stomach (25 patients) underwent ESD between September 2008 and December 2011. Demographics, clinical data, therapeutic outcomes, complications, pathological characteristics, risk classification, and follow-up outcomes were recorded.
  
  
  RESULTS
  ESD was successfully performed in 31 patients at age of 59.06 ± 7.23 years (range: 46-74). The mean time of the procedure was 70.16 ± 16.25 min (range: 40-105). Perforation for 2-10 mm occurred in six patients (19.35%) and was endoscopically repaired with clips or nylon bands, with no conversions to open surgery. Intraoperative bleeding occurred in three patients (9.68%) and was corrected with argon plasma coagulation or hot biopsy forceps. No mortalities occurred. The mean size of the resected tumors was 2.70 ± 0.72 cm (range: 2.0-5.0). Out of the 31 patients, 24 (77.42%) were at very low risk and 7 (22.58%) were at low risk. Positive rate of CD117, DOG-1, and CD34 were 83.87%, 12.90%, and 100%, respectively. A follow up for 14.29 ± 8.99 months (range: 3-39) showed no recurrence or metastasis.
  
  
  CONCLUSIONS
  ESD appears to be an effective, safe, and feasible treatment for large-size GISTs in the esophagus and stomach.
authors.affiliation: Department of Digestive Diseases, General Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Zhankun
authors.initials: Z
authors.lastname: He
authors.forename: Chao
authors.initials: C
authors.lastname: Sun
authors.forename: Zhongqing
authors.initials: Z
authors.lastname: Zheng
authors.forename: Qingxiang
authors.initials: Q
authors.lastname: Yu
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.forename: Hailong
authors.initials: H
authors.lastname: Cao
authors.forename: Wentian
authors.initials: W
authors.lastname: Liu
authors.forename: Bangmao
authors.initials: B
authors.lastname: Wang
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor