Characterization of subepithelial tumors of upper gastrointestinal tract by endoscopic ultrasound

Abstract

In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors (GISTs). Esophageal GIST is a rare type of mesenchymal tumor. GISTs originate from the interstitial cells of Cajal, which are pacemaker cells involved in gut motility. GISTs are most commonly found in the stomach and small intestine, but esophageal involvement is rare. Esophageal GISTs account for < 1% of all GISTs. Endoscopic resection remains the mainstay for small, localized tumors with excellent outcomes. However, larger tumors may require multidisciplinary strategies to provide the best oncological outcomes. Here, we discuss the usefulness of endoscopic ultrasound (EUS) of subepithelial tumors of the upper gastrointestinal tract. EUS is a crucial tool in the diagnosis, staging, and management of subepithelial masses. Given the subepithelial nature of these tumors, standard endoscopy is not adequate, making EUS essential for a comprehensive assessment. EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy, for treatment planning.

Keywords: Subepithelial tumors; Esophageal gastrointestinal stromal tumors; Endoscopic ultrasound; Artificial intelligence; Endoscopic resection

Core Tip: Esophageal gastrointestinal stromal tumor (GIST) is a rare type of mesenchymal tumor. Esophageal GISTs account for < 1% of all GISTs. Endoscopic resection remains the mainstay for small, localized tumors with excellent outcomes. Endoscopic ultrasound (EUS) is a crucial tool in the diagnosis, staging, and management of esophageal GIST. Given the submucosal nature of these tumors, standard endoscopy is not adequate, making EUS essential for a comprehensive assessment. EUS provides accurate tumor sizing, and enables fine needle aspiration guided biopsy of carefully selected large inoperable tumors or where diagnosis is in doubt, which is critical for risk stratification and treatment planning.