title: The true incidence of gastric GIST-a study based on morbidly obese patients undergoing sleeve gastrectomy.
abstract: BACKGROUND
  Gastrointestinal stromal tumor (GIST) is a rare neoplasm of the alimentary tract. Previous reports described an incidence of 1 per 100,000. Laparoscopic sleeve gastrectomy (LSG) provides pathological specimens of the majority of the stomach. We examined the pathology from LSG and the incidence and location of GIST. The aim of this study was to study the incidence of asymptomatic GISTs found during LSG at our institution.
  
  
  METHODS
  A search was conducted in a prospectively maintained bariatric registry. Data collected included the following: gender, age, body mass index (BMI), and concomitant hypertension or diabetes mellitus. Histopathology reports were reviewed for incidental GIST. We compared the patients with incidental GIST to the rest of the cohort.
  
  
  RESULTS
  Pathology reports of 827 patients that underwent LSG between 2007 and 2014 were reviewed. Five patients had GIST in the resected stomach, an incidence of 0.6 %. The group of patients with GIST had lower BMI and older age compared to the remaining 822 patients. All tumors were located close to the lesser curvature.
  
  
  CONCLUSIONS
  The incidence of GIST found in this cohort is significantly higher than previously reported. This may be due to an association between these tumors and obesity or because asymptomatic GISTs are underdiagnosed in the general population. These tumors are particularly common in older patients and special attention must be given when performing LSG on this subpopulation. The stomach should be inspected thoroughly before resection. A tumor on the lesser curvature may necessitate changing the surgical plan or aborting the procedure.
authors: Department of General Surgery, Hadassah-Hebrew University Medical Center, Kyriat Hadassah, P.O. Box 12000, Jerusalem, 91120, Israel, jyuval@gmail.com.
authors: Jonathan B
authors: JB
authors: Yuval
authors: Abed
authors: A
authors: Khalaileh
authors: Mahmoud
authors: M
authors: Abu-Gazala
authors: Yair
authors: Y
authors: Shachar
authors: Andrei
authors: A
authors: Keidar
authors: Yoav
authors: Y
authors: Mintz
authors: Aviram
authors: A
authors: Nissan
authors: Ram
authors: R
authors: Elazary
mesh_terms: D000328:Adult; D001706:Biopsy; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods; D046152:Gastrointestinal Stromal Tumors / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology