Nationwide Multicenter Study of Advanced Endoscopic Resection and Malignant Risk Model for Gastric Myogenic Tumors...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Gastric subepithelial lesions (SELs) are increasingly prevalent.
• Endoscopic resection (ER) offers a minimally invasive approach for managing gastric SELs.
• Gastric myogenic tumors require effective and safe treatment strategies.

Purpose of the Study:

• To evaluate the efficacy and safety of ER for gastric myogenic tumors.
• To identify predictors for distinguishing gastrointestinal stromal tumors (GISTs) from other myogenic tumors.
• To develop a predictive model for GISTs based on clinical and endoscopic ultrasound (EUS) features.

Main Methods:

• Retrospective analysis of 325 patients with gastric myogenic tumors from nine tertiary centers (2012-2024).
• Inclusion of patients treated with various ER techniques: endoscopic muscular dissection (EMD), endoscopic subserosal dissection (ESSD), submucosal tunneling endoscopic resection (STER), and endoscopic full-thickness resection (EFTR).
• Analysis of clinical manifestations, endoscopic features, procedural outcomes, and follow-up data.

Main Results:

• High technical success (97.0%), en bloc (94.3%), and R0 resection (88.9%) rates were achieved with ER.
• Low complication rate (6.3%) and no recurrence during a mean follow-up of 921.4 days.
• Old age, fundus location, heterogeneous echotexture, and exophytic growth were independent predictors for GISTs, forming a predictive model with an AUC of 0.8771.

Conclusions:

• Endoscopic resection is an efficient and safe management option for gastric myogenic tumors.
• Demographic characteristics and EUS features can effectively predict the histological type of gastric myogenic tumors.
• The developed prediction model aids in differentiating GISTs from other myogenic tumors pre-procedurally.