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Successful Endoscopic Resection of a Rectal Gastrointestinal Stromal Tumor Larger Than 5 cm
Seong Jung Kim1, Yun Jung1, Ran Hong2
1Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
Abstract:
Preoperative imatinib treatment for rectal gastrointestinal stromal tumors (GISTs) has been reported to reduce the tumor size and help preserve the anal sphincter function. On the other hand, preoperative imatinib may prevent an accurate assessment of the recurrent risk. The endoscopic resection of rectal GIST is rarely reported because of challenges that include securing the visual field and avoiding perforation. This paper reports a case in which a 5.5×4.0 cm sized rectal GIST was treated effectively by an endoscopic submucosal dissection (ESD) without preoperative imatinib. To date, the patient had no tumor recurrence or complications and is receiving adjuvant imatinib treatment. This case shows that ESD may be a good treatment option to preserve the anus in rectal GIST treatment.
Insights
Endoscopic submucosal dissection (ESD) offers an effective treatment for large rectal gastrointestinal stromal tumors (GISTs), potentially preserving anal sphincter function without preoperative imatinib. This approach allows for accurate risk assessment and avoids complications associated with neoadjuvant therapy.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Preoperative imatinib is used for rectal gastrointestinal stromal tumors (GISTs) to reduce size and preserve anal sphincter function.
- However, preoperative imatinib can hinder accurate recurrence risk assessment.
- Endoscopic resection of rectal GISTs is challenging due to visualization and perforation risks.
Observation:
- A case study details the effective endoscopic submucosal dissection (ESD) of a 5.5x4.0 cm rectal GIST without preoperative imatinib.
- The patient experienced no tumor recurrence or complications post-procedure.
- The patient is currently receiving adjuvant imatinib therapy.
Findings:
- Endoscopic submucosal dissection (ESD) can be a viable and effective treatment for large rectal GISTs.
- This method may obviate the need for preoperative imatinib, allowing for precise risk stratification.
- Successful ESD can lead to favorable outcomes, including anal sphincter preservation.
Implications:
- ESD represents a promising organ-preserving surgical option for rectal GISTs.
- Avoiding neoadjuvant imatinib may improve the accuracy of post-treatment surveillance for recurrence.
- This case highlights the potential of ESD in managing rectal GISTs, particularly larger ones where sphincter preservation is critical.
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