Vogli S, Papadakos SP, Argyrou A, Schizas D. Expanding the role of endoscopic resection in esophageal gastrointestinal stromal tumors: Insights and challenges. World J Gastroenterol 2025; 31(20): 106441 [DOI: 10.3748/wjg.v31.i20.106441]
Corresponding Author of This Article
Dimitrios Schizas, MD, PhD, The First Department of Surgery, "Laikon" General Hospital, National and Kapodistrian University of Athens, 30 Panepistimiou Street, Athens 11527, Greece. schizasad@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 28, 2025; 31(20): 106441 Published online May 28, 2025. doi: 10.3748/wjg.v31.i20.106441
Expanding the role of endoscopic resection in esophageal gastrointestinal stromal tumors: Insights and challenges
Stamatina Vogli, Stavros P Papadakos, Alexandra Argyrou, Dimitrios Schizas
Stamatina Vogli, Department of Gastroenterology, Metaxa Oncologic Hospital of Piraeus, Piraeus 18537, Attikí, Greece
Stavros P Papadakos, Alexandra Argyrou, The First Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens 11527, Greece
Dimitrios Schizas, The First Department of Surgery, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
Co-first authors: Stamatina Vogli and Stavros P Papadakos.
Author contributions: Vogli S and Papadakos SP contributed equally to this study as co-first authors; Vogli S and Schizas D designed the overall concept and outline of the manuscript; Papadakos SP and Argyrou A contributed to the literature review and manuscript drafting; Vogli S drafted the manuscript; Papadakos SP and Argyrou A critically reviewed and edited the manuscript for important intellectual content; Schizas D made the final corrections to the manuscript and completed the final review; Papadakos SP provided final language revision of the manuscript as a native English speaker; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript. No financial, professional, or personal relationships could have influenced the work presented in this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Schizas, MD, PhD, The First Department of Surgery, "Laikon" General Hospital, National and Kapodistrian University of Athens, 30 Panepistimiou Street, Athens 11527, Greece. schizasad@gmail.com
Received: February 26, 2025 Revised: April 3, 2025 Accepted: April 18, 2025 Published online: May 28, 2025 Processing time: 91 Days and 8.9 Hours
Abstract
While rare, esophageal gastrointestinal stromal tumors (GISTs) have higher malignant potential and are typically diagnosed at larger sizes compared to gastric GISTs. However, well-defined guidelines for their optimal management remain lacking. Most esophageal GISTs are surgically managed with enucleation, while esophagectomy is reserved for larger tumors. Recent advances in endoscopic techniques, such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection (ER), have allowed for endoscopic removal of submucosal esophageal lesions, including GISTs. Xu et al reported on the clinical and oncological outcomes of 32 patients with esophageal GISTs treated with ER. The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival. However, it primarily focused on small, incidentally detected GISTs, with 75% of cases classified as very low or low risk according to the National Institutes of Health criteria. The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus. In this editorial, we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches. We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.
Core Tip: Esophageal gastrointestinal stromal tumors are exceedingly rare and tend to be diagnosed at larger sizes with higher malignant potential than their gastric counterparts. Although definitive management guidelines remain lacking, surgical resection has traditionally been the primary treatment. However, recent advancements in endoscopic techniques now offer promising minimally invasive alternatives that can help patients who are not candidates for esophagectomy.
