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Updated: Jun 3, 2025
Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
Published on: February 19, 2022
Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors
Osamu Goto1,2, Kazutoshi Higuchi1, Eriko Koizumi1
1Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Abstract:
Peroral flexible endoscopy is a minimally invasive technique that enables the local resection of gastric subepithelial tumors (SETs) with malignant potential. Resection techniques are mainly chosen on the basis of the lesion size. Minute SETs less than 1 cm should be managed through a watch and wait strategy, with the exception of histologically diagnosed superficial lesions, which require endoscopic mucosal resection or endoscopic submucosal dissection. For 1- to 3-cm small SETs, endoscopic enucleation techniques, such as endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and peroral endoscopic tumor resection, can be used. However, endoscopic full-thickness resection is preferred for histologically complete removal with negative surgical margins. When endoscopic full-thickness resection is considered technically difficult, laparoscopic and endoscopic cooperative surgery (LECS) is a safe and dependable alternative. Moderate-sized SETs (3 to 5 cm) require surgical intervention because the lesions must be removed transabdominally. LECS is a less invasive surgical procedure as it reduces the resection area; however, some LECS techniques that require transoral tumor retrieval are not available. Endoscopic intervention for lesions larger than 5 cm should be used with caution for research purposes. With advancements in endoscopic diagnosis, the indications for endoscopic treatment for SETs are expected to improve, thereby enhancing patients' quality of life.
Insights
Endoscopic resection is a minimally invasive option for gastric subepithelial tumors (SETs). Treatment choice depends on SET size, ranging from observation to advanced endoscopic or surgical techniques for optimal patient outcomes.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Oncology
Background:
- Gastric subepithelial tumors (SETs) pose a risk of malignancy and require careful management.
- Peroral flexible endoscopy offers a minimally invasive approach for local resection of SETs.
- Current treatment strategies are primarily guided by tumor size and histological characteristics.
Purpose of the Study:
- To review and delineate the current endoscopic and surgical management strategies for gastric subepithelial tumors (SETs).
- To correlate tumor size with appropriate resection techniques, including endoscopic and combined laparoscopic-endoscopic approaches.
- To discuss the evolving role of endoscopy in SET treatment and its impact on patient quality of life.
Main Methods:
- Review of literature on endoscopic and surgical resection techniques for gastric subepithelial tumors.
- Classification of SET management based on lesion size (e.g., <1 cm, 1-3 cm, 3-5 cm, >5 cm).
- Comparison of different endoscopic resection modalities (EMR, ESD, EEE, STET, PETR, EFTR) and laparoscopic and endoscopic cooperative surgery (LECS).
Main Results:
- Minute SETs (<1 cm) are typically managed with surveillance, except for superficial lesions requiring EMR or ESD.
- Small SETs (1-3 cm) can be treated with endoscopic enucleation techniques or EFTR for complete removal.
- Moderate SETs (3-5 cm) often necessitate transabdominal surgical intervention, with LECS offering a less invasive alternative.
Conclusions:
- The choice of resection technique for gastric SETs is critically dependent on tumor size and requires a tailored approach.
- Endoscopic full-thickness resection and LECS represent valuable, less invasive options for specific SET sizes.
- Advancements in endoscopic diagnostics and techniques are expected to expand endoscopic treatment indications, improving patient outcomes.
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