Advancements in endoscopic resection of gastrointestinal stromal tumors: Techniques, outcomes, and perspectives

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal. They predominantly affect individuals between 50 and 70 years of age and often carry malignant potential despite being frequently asymptomatic. The stomach and small intestine are the most common locations, while involvement of the esophagus, colon, or rectum is relatively rare. GISTs are often discovered incidentally during endoscopic or radiologic evaluations, and the diagnosis is confirmed through tissue biopsy and immunohistochemical staining, particularly for KIT (CD117), DOG1, and PDGFRA. In the past decade, laparoscopic resection has been considered the standard treatment for localized GISTs smaller than 5 cm. However, recent advances in endoscopic technology have led to a growing role for endoscopic resection as a safe and effective treatment option for selected nonmetastatic GISTs. Endoscopic techniques such as endoscopic submucosal dissection, endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and endoscopic full-thickness resection have demonstrated favorable outcomes, including high complete resection (R0) rates, shorter hospital stays, and quicker recovery compared to traditional surgery. The selection of an appropriate resection method depends on tumor size, location, depth of invasion, and proximity to vital structures. Endoscopic ultrasound has become an essential tool for preprocedural assessment, providing detailed information on tumor characteristics and helping to guide management decisions. While endoscopic resection is a promising minimally invasive approach, it should be performed by skilled endoscopists with appropriate training due to the technical complexity and risk of complications such as bleeding or perforation. This review summarizes recent developments in endoscopic resection of GISTs, with a focus on indications, procedural safety, clinical outcomes, and recommendations for optimal patient selection and procedural planning.