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The progression rate and risk factor analysis of small gastric subepithelial tumors: a systematic review and

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  • 1Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.

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Most small gastric subepithelial tumors (SETs) do not grow during surveillance, especially those under 1 cm. Lesions over 1 cm, originating from the muscularis propria, or showing specific endoscopic features require closer monitoring.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Endoscopic Imaging

Background:

  • Small gastric subepithelial tumors (SETs) management is debated, with uncertainty regarding progression rates under surveillance.
  • Determining the natural history of untreated SETs is crucial for clinical decision-making.

Purpose of the Study:

  • To evaluate the progression rate of small gastric subepithelial tumors (SETs) during surveillance.
  • To identify risk factors associated with tumor growth in small gastric SETs.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, Cochrane, Web of Science, Scopus) until March 2023.
  • Data extraction included patient demographics, SET endoscopic features, and surveillance outcomes.
  • A random-effects model was employed for meta-analysis, supplemented by subgroup and sensitivity analyses.

Main Results:

  • Analysis of 14 studies involving 5405 SETs (<3.5 cm) revealed an annual size increase incidence of 4.0 per 100 person-years.
  • The overall incidence of tumor growth was 12.8% over an average surveillance period of approximately 51 months.
  • Risk factors for growth included lesion size (≥1 cm), muscularis propria origin, mucosal changes, irregular margins, and hypoechoic endoscopic ultrasound patterns.

Conclusions:

  • The majority of small gastric SETs, particularly those <1 cm, exhibit stable size during surveillance.
  • Gastric SETs ≥1 cm, originating from the muscularis propria, or displaying specific endoscopic features (mucosal change, irregular margin, hypoechoic pattern) warrant increased vigilance.