Endoscopic Submucosal Dissection For Small Gists And The Analysis Of The Risk Factors

Aims:The aim of this study is to evaluate the feasibility of endoscopic submucosal dissection (ESD) for small-size (<30mm) gastrointestinal stromal tumors and analyze the risk factors.Methods:We reviewed24patients (2patients with2lentions) with26lesions underwent ESD of GISTs from march2008to December2011in the2nd Affiliated Hospital of Zhejiang University, and analyzed the influences of the age, sex, tumor size, location, origin, operation time to the success rate and Hospitalization period, the influence of tumor location to the operation time, and the Risk assessment of the tumors were taken according to the microscopic characters of the tumors.Result:All the24patients were at the very low to low risk;10(38.46%) lesions were located at the esophagus while16were in the stomach, the average size was1.43±0.56cm, average operation time was49.08±31.96min (esophagus 26.60±13.95min, stomach63.13±32.23min, p<0.05),the resection rate was92.3%(24/26), the success rate was73.07%(19/26), and it was related with the tumor origin, the success rate of tumors originating in the muscularis propria layer are much higher than the muscularis mucosae propria layer’s, and its had no relationship to the age, sex, tumor size, location, and operation time.The esophageal GISTs were similar with the gastric GISTs in patients’age, tumor size, but the operation time was significantly shorter than the stomach; the average Hospitalization period was6.00±2.82d (success group5.12±2.07d, failure group8.50±3.51d, p<0.05).Conclusions:ESD is feasible and effective for small-size (esophageal/gastric) GISTs, but when it refer to the tumors originating in the muscularis propria layer, much caution should be paid as the success rate will be much lower with a longer Hospitalization period. Esophageal GISTs originating in the muscularis mucosa propria layer could be treated by the ESD directly while maybe the GISTs of muscularis propria layer should be under EUS surveillance.