• Efficacy
• Endoscopic full-thickness resection
• Gastrointestinal stromal tumors
• Progression-free survival
• Propensity score matching
• Surgical resection

• acute gastrointestinal bleed
• duodenal
• duodenal gist
• endoscopic ultrasound (eus)
• gastrointestinal stromal tumor (gist)
• melena
• subepithelial lesion

• Area under curve
• Gastrointestinal stromal tumors
• ROC curve
• Risk assessment
• Tomography, X-ray computed

• Artificial intelligence
• Deep learning
• Endoscopic ultrasound
• Gastrointestinal stromal tumors
• Submucosal tumors

• Humans
• Endosonography/methods
• Gastrointestinal Stromal Tumors/diagnostic imaging
• Gastrointestinal Stromal Tumors/pathology
• Artificial Intelligence

• Endosonography
• Esophagus
• Gastrointestinal Stromal Tumors
• Subepithelial Tumors

• Endosonography
• Esophageal Neoplasms/diagnostic imaging
• Esophageal Neoplasms/pathology
• Gastrointestinal Stromal Tumors/diagnostic imaging
• Gastrointestinal Stromal Tumors/pathology
• Humans
• Leiomyoma/diagnostic imaging
• Retrospective Studies

Rectal subepithelial lesions (SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abnormal tissues are not easily to be obtained by regular endoscopic forceps biopsy. Traditional guidance modalities of preoperative biopsy, including endoscopic ultrasound, computed tomography, and transabdominal ultrasound, are often unsatisfactory. An updated, safe, and effective biopsy guidance method is required. We herein report a new biopsy guidance modality—endorectal ultrasound (ERUS) combined with contrast-enhanced ultrasound (CEUS).

A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy (CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.

Transperineal CNB guided by ERUS and CEUS is a safe and effective preoperative biopsy of rectal SELs yet with some limitations.

• Transperineal core needle biopsy
• Endorectal ultrasound
• Contrast-enhanced ultrasound
• Rectal subepithelial lesion
• Case report

• Adult
• Biopsy, Large-Core Needle
• Female
• Gastrointestinal Stromal Tumors
• Humans
• Neoplasm Recurrence, Local
• Rectum/diagnostic imaging
• Rectum/surgery
• Retrospective Studies

• Endoscopic ultrasonography
• Endoscopy
• Gastrointestinal stromal tumors
• Multidetector computed tomography
• Risk assessment

• Artificial intelligence
• Convolutional neural network
• Deep learning
• Endoscopic ultrasound
• Gastrointestinal tumors
• Subepithelial lesion

• calcifying fibrous tumor
• gastrointestinal stromal cell tumors
• submucosal tumor

• Child
• Diagnostic Errors
• Female
• Gastrointestinal Stromal Tumors/diagnostic imaging
• Gastrointestinal Stromal Tumors/surgery
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasms, Fibrous Tissue
• Retrospective Studies
• Stomach/diagnostic imaging
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/surgery

Gastrointestinal stromal tumor (GIST) is a rare but an important clinical entity seen in our clinical practice. It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine. Although the exact prevalence of GIST is not known, the incidence of GIST has been increasing. GISTs arise from interstitial cells of Cajal. Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene. 15% of GISTs do not have these mutations and they are called wild-type GISTs. Almost all GISTs express KIT receptor tyrosine kinase. Histologically, GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type. The median size of GISTs varies from 2.7 cm to 8.9 cm. Clinically, patients with small GISTs remain asymptomatic but as the GIST size increases, patients present with various symptoms depending on the location of the GIST. Most of GISTs are located in the stomach or small bowel. Diagnosis is suspected on imaging and endoscopic studies, and confirmed by tissue acquisition with immunohistochemical staining. The aggressiveness of GISTs depends on the size, mitotic index and location. Surgical resection is the treatment of choice. But various endoscopic modalities of resection are increasingly being tried. Tyrosine kinase inhibitors are extremely useful in the management of large GISTs, unresectable GISTs and metastatic GISTs. Treatment options for metastatic GISTs also include radiotherapy, chemotherapy, hepatic artery embolization, chemoembolization and radiofrequency ablation.

• Gastrointestinal stromal tumor
• Mesenchymal tumor of gastrointestinal tract
• Gastrointestinal subepithelial tumors
• Management of gastrointestinal stromal tumor
• Familial gastrointestinal stromal tumor
• Risk stratification

Gastric gastrointestinal stromal tumours (GISTs) are rare neoplasms that require excision for cure. Although the feasibility of laparoscopic resection of smaller gastric GIST has been established, the feasibility and long-term efficacy of these techniques are unclear in larger lesions. This study is done to assess the feasibility of the laparoscopic resection of gastric GISTs and their long-term outcomes.

Patients who underwent laparoscopic resection of gastric GISTs were identified in a prospectively collected database. Outcome measures included patient demographics, operative findings, morbidity and histopathologic characteristics of the tumour. Patient and tumour characteristics were analysed to identify risk factors for tumour recurrence.

There were 42 patients with a mean age of 56.7 years and had a mean tumour size was 4.5 ± 2.7 cm. Laparoscopic wedge resection was the most common procedure done. There were no major perioperative complications or mortalities. All lesions had negative resection margins. At a mean follow-up of 48 months, 36/39 (92.3%) patients were disease free and 3/39 (7.6%) had progressive disease. Univariate analysis showed that there was a statistically significant association of disease progression with tumour size, high mitotic index, tumour ulceration and tumour necrosis. The presence of >10 mitotic figures/50 high-power field was an independent predictor of disease progression.

Our study establishes laparoscopic resection is feasible and safe in treating gastric GISTs for tumours >5 cm size. The long-term disease-free survival in our study shows acceptable oncological results in comparison to historical open resections.

• Gastric gastrointestinal stromal tumours
• laparoscopic wedge resection
• submucosal tumours

• Endoscopic submucosal dissection (ESD)
• Endoscopic submucosal excavation (ESE)
• Gastrointestinal (GI)
• Multiband mucosectomy (MBM)
• Submucosal tumours (SMTs)

The incidence of asymptomatic and incidentally found upper gastrointestinal subepithelial tumors (SETs) is increasing with the implementation of national cancer screening and the development of high-resolution endoscopy in Korea. However, endoscopy alone cannot be used to determine whether SETs are benign or malignant. Endoscopic ultrasound (EUS) is used to further characterize these lesions through the examination of their layered structure, internal echogenicity, size, and relationship to the extramural structure. These provide additional information on whether the lesion is benign or malignant. Nevertheless, the sensitivity and specificity of EUS alone in predicting malignancy is unsatisfactory. Recent guidelines have recommended deciding the timing of EUS-fine needle aspiration and biopsy (EUS-FNA/B) for SETs based on tumor size, malignant features on endoscopy, and high-risk features on EUS. The diagnostic accuracy of EUS-FNA/B is reportedly influenced by factors including needle size, number of needle passes, use of suction, use of a stylet in the needle assembly, fanning technique, availability of an on-site cytopathologist, and experience of the endosonographer. Therefore, according to the characteristics of the SETs, various subsequent methods and techniques should be appropriately employed to improve the diagnostic yield of EUS-FNA/B.

• Endoscopic ultrasound
• Stomach
• Subepithelial tumor

Gastric stromal tumor is a digestive tract mesenchymal tumor with malignant potential, and endoscopic techniques have been widely used in the treatment of gastric stromal tumors, but there is still controversy over their use for large gastric stromal tumors (≥ 3 cm).

To evaluate the clinical long-term efficacy and safety of endoscopic resection for large (≥ 3 cm) gastric stromal tumors.

All patients who underwent endoscopic resection or surgery at our hospital from 2012 to 2017 for pathologically confirmed gastric stromal tumor with a maximum diameter of ≥ 3 cm were collected. The clinical data, histopathologic characteristics of the tumors, and long-term outcomes were recorded.

A total of 261 patients were included, including 37 patients in the endoscopy group and 224 patients in the surgical group. In the endoscopy group, the maximum tumor diameter was 3-8 cm; the male: Female ratio was 21/16; 34 cases had low-risk tumors, 3 had intermediate-risk, and 0 had high-risk; the mean follow-up time was 30.29 ± 19.67 mo, no patient was lost to follow-up, and no patient received chemotherapy after operation; two patients with recurrence had low-risk stromal tumors, and neither had complete resection under endoscopy. In the surgical group, the maximum tumor diameter was 3-22 cm; the male: Female ratio was 121/103; 103 cases had low-risk tumors, 75 had intermediate-risk, and 46 had high-risk; the average follow-up time was 38.83 ± 21.50 mo, 53 patients were lost to follow-up, and 8 patients had recurrence after operation (6 cases had high-risk tumors, 1 had intermediate-risk, and 1 had low-risk). The average tumor volume of the endoscopy group was 26.67 ± 26.22 cm³ (3.75-120), all of which were less than 125 cm³. The average volume of the surgical group was 273.03 ± 609.74 cm³ (7-4114). Among all patients with a tumor volume < 125 cm³, 7 with high-risk stromal tumors in the surgical group (37.625 cm³ to 115.2 cm³) accounted for 3.8% (7/183); of those with a tumor volume < 125 cm³, high-risk patients accounted for 50% (39/78). We found that 57.1% (12/22) of patients with high-risk stromal tumors also had endoscopic surface ulcer bleeding and tumor liquefaction on ultrasound or abdominal computed tomography; the ratio of tumors positive for both in high-risk stromal tumors with a volume < 125 cm³ was 60% (3/5).

Endoscopic treatment is safe for 95.5% of patients with gastric stromal tumors with a tumor diameter ≥ 3 cm and a volume of < 125 cm³ without endoscopic surface ulcer bleeding or CT liquefaction.

• Endoscopic resection
• Surgery
• Gastric stromal tumor
• Clinical evaluation

• Cellulose
• Gastric emptying
• Scintigraphy
• Semisolid
• Ultrasound

• Administration, Oral
• Adult
• Cellulose/administration & dosage
• Contrast Media/administration & dosage
• Female
• Gastric Emptying/physiology
• Humans
• Image Enhancement/methods
• Male
• Reference Values
• Stomach/diagnostic imaging
• Stomach/physiology
• Ultrasonography/methods

• Endoscopic surgical procedures
• gastric neoplasm
• gastrointestinal stromal tumor (GIST)

• endoscopic resection
• endoscopic ultrasound
• gastric schwannoma
• gastric submucosal tumor

• Adult
• Aged
• Endosonography
• Female
• Follow-Up Studies
• Gastroscopy
• Humans
• Immunochemistry
• Male
• Middle Aged
• Neurilemmoma/diagnostic imaging
• Neurilemmoma/pathology
• Neurilemmoma/surgery
• Retrospective Studies
• Stomach/diagnostic imaging
• Stomach/pathology
• Stomach/surgery
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome
• Ultrasonography, Interventional

• Abdominal tumor
• GIST
• Gastric mass
• Gastrointestinal stromal tumor
• Imatinib
• Sunitinib
• TKIs
• Tyrosine kinase inhibitor

Gastrointestinal stromal tumors are the most common mesenchymal neoplasms affecting the gastrointestinal tract. The stomach is the most common location to be affected, and the rectum one of the rarest, but the whole gastrointestinal tract remains susceptible. Gastrointestinal stromal tumors account for only 0.1% of rectal tumors. Currently, endoscopic ultrasound plays an essential role in the diagnostic process of gastrointestinal stromal tumors, especially when the affected sites have a worse outcome and higher morbidity rates.

We describe the case of a 68-year-old white Japanese man with a history of long-term mild rectal pain and tenesmus. A digital rectal examination revealed a right palpable solid mass ranging from 3 to 7 cm from his anal verge. A colonoscopy was performed and showed a 5 cm elevated lesion covered by normal mucosa, located 4 cm above the pectineal line. Endoscopic ultrasound confirmed the diagnosis of a homogeneous hypoechoic mass with areas of necrosis as a rectal subepithelial lesion originating at the fourth layer (muscularis propria). He then underwent endoscopic ultrasound-guided fine needle aspiration of the lesion, followed by cytological and immunohistochemistry evaluation. The evaluation showed spindle and epithelioid cells of variable sizes, in fascicles separated by stroma, which reacted firmly and consistently to CD117/c-kit and CD34, and negative to desmin and S-100 protein. There was weak staining for nuclear Ki-67 in the tumor cells. A diagnosis of rectal gastrointestinal stromal tumor was confirmed. After a multidisciplinary meeting, an abdominoperineal resection of his rectum was performed. The pathology of the specimen confirmed the diagnosis of rectal gastrointestinal stromal tumor. He is now asymptomatic after 3 months’ follow-up and is on adjuvant therapy with a tyrosine-kinase inhibitor.

Gastrointestinal stromal tumors are rare tumors, and among the variety of primary location sites, the rectum is one of the rarest. The localization of this type of tumor has worse outcomes and higher morbidity rates. We report this rare case to emphasize the need for precise diagnosis and the important role of endoscopic ultrasound-guided fine needle aspiration in such situations.

• Case report
• Endoscopic ultrasound
• Endoscopic ultrasound-fine needle aspiration
• Gastrointestinal stromal tumors
• Immunohistochemistry
• Rectum

Gastrointestinal stromal tumors (GISTs) constitute the most common mesenchymal neoplasms of the gastrointestinal tract, among which 60%-70% are located in the stomach. All GISTs have malignant potential, varying from small lesions to aggressive sarcomas. Surgical resection with negative margins remains the best treatment for GISTs. Lymphadenectomy is not necessary because GISTs rarely metastasize to lymph nodes. Because of these biological behavior characteristics, the advantages of minimally invasive surgeries such as laparoscopic surgery and endoscopic surgery can be fully reflected in the surgical management of GISTs. The advent of laparoscopic and endoscopic cooperative surgery has broadened the scope and enhanced the safety of minimally invasive surgical treatment of GISTs. In this paper we will discuss the application of laparoscopy, endoscopy and laparoscopic and endoscopic cooperative surgery in the treatment of GISTs.

• Gastrointestinal stromal tumors
• Laparoscopy
• Endoscopy