Endoscopic ultrasonography in the study of extramucosal swellings in the upper digestive tract

Laparoscopic versus Open Resection for Gastric Gastrointestinal Stromal Tumors: A Meta-analysis

We conducted our meta-analysis to compare outcomes between laparoscopic resection and open resection for gastric gastrointestinal stromal tumors (GISTs) from all published comparative studies in the literature. Databases, including PubMed, Embase, Cochrane Library, Ovid, Web of Science, and CNKI, were searched to identify studies comparing outcomes after laparoscopic resection and open resection for gastric GISTs. The meta-analysis was performed by RevMan 5.1. Eleven comparative studies comprising 495 patients were identified. Patients undergoing laparoscopic resection of gastric GISTs were found to have similar operative time (weighted mean difference [WMD], 2.29; 95% confidence interval [CI], -16.01 to 11.43; P = 0.74) and complications rate (odds ratio [OR], 0.76; 95% CI, 0.36 to 1.58; P = 0.46). Less intraoperative blood loss (WMD, -55.91; 95% CI, -90.26 to -21.56; P = 0.001), earlier passing first flatus (WMD, -0.89, 95% CI, -1.60 to -0.18; P = 0.01), earlier having the first liquid diet (WMD, -1.54; 95% CI, -2.44 to -0.64; P = 0.0008), and shorter hospital stay (WMD, -4.25; 95% CI, -5.63 to -2.88; P < 0.00001) were observed in the laparoscopic resection group. The recurrence rate was higher in the group of open resection compared with the group of laparoscopic resection (OR, 0.26; 95% CI, 0.09 to 0.75; P = 0.01). Laparoscopic resection is safe and efficient in the treatment of patients with gastric GISTs as compared with open resection procedure. Laparoscopic resection may be a preferred treatment for gastric GISTs.

Gastric Schwannoma: A Tumor Must Be Included in Differential Diagnoses of Gastric Submucosal Tumors

Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Due to its rarity, GS is not widely recognized by clinicians, and the precise differential diagnosis between GS and other gastric submucosal tumors remains difficult preoperatively. The present study reports a case of GS misdiagnosed as gastrointestinal stromal tumor and reviews the clinical, imaging, and pathological features, treatment, and follow-up of 221 patients with GS previously reported in the English literature. Although GS is rare, the case reported in the current study highlights the importance of including GS in differential diagnoses of gastric submucosal tumors. Furthermore, the findings of the review suggest that although many cases are asymptomatic, the most common symptoms are abdominal pain or discomfort, not gastrointestinal bleeding, and malignant GSs present with clinical symptoms more commonly. Although large-sample multicenter studies on the efficacy, safety, and oncological outcomes of minimally invasive techniques are required, the findings presented herein may be helpful for clinicians when diagnosing or treating GS.

Endosonographic evaluation of patients with suspected extraluminal compression or subepithelial lesions during upper gastrointestinal endoscopy

BACKGROUND

The aim of this study was to evaluate the endosonographic ultrasound (EUS) findings of patients with suspected extraluminal compression or subepithelial intramural lesions observed during upper gastrointestinal endoscopy.

METHODS

EUS findings were grouped as follows; compression by an extramural pathologic lesion, compression by an adjacent vascular structure, compression by adjacent organs, subepithelial intramural lesion, and normal EUS.

RESULTS

The data of 211 patients referred to the EUS unit between February 2004 and January 2010 for further evaluation of suspected extraluminal compression or subepithelial intramural lesions after upper gastrointestinal endoscopy were retrospectively analyzed. Mean age of the patients was 51.0±15.2 years, 124 (58.9%) of which were female. EUS examination was normal in 48 (22.7%) patients. EUS confirmed the presence of a pathological finding in the esophagus in 38 (92.6%) out of 41 patients when compared with abnormal findings in 122 (73.4%) of 166 patients who were evaluated for suspected lesions of the stomach (P=0.009). Suspected extraluminal compression of the esophagus (n=41) was due to a vascular structure in 17 (41.4% ) patients, an adjacent organ in four (9.7%) patients, an extramural pathological lesion in two (4.9%) patients, and a subepithelial intramural lesions in 15 (36.6%) patients, whereas in three patients (7.4%) EUS findings were normal. Of the 166 patients referred for evaluation of gastric lesions EUS findings were normal in 44 (26.5%) patients, whereas compression due to an adjacent organ was observed in 66 (39.7%) patients followed by compression by an adjacent vascular structure in 34 (20.4%) patients. An extramural pathologic lesion was discovered in 14 (8.6%) patients, whereas suspected compression was due to a subepithelial intramural lesion in eight (4.8%) patients.

CONCLUSION

Accurate diagnosis of suspected extraluminal compression or subepithelial intramural lesions, particularly in the stomach, requires meticulous evaluation. EUS provides an invasive but effective option. In one-third of cases, suspected extraluminal compression of the esophagus is actually due to a subepithelial intramural lesion.

Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach: preliminary results

INTRODUCTION

Gastrointestinal stromal tumors (GISTs) are rare neoplasms with malignant potential. Surgery is the definitive management for resectable nonmetastatic lesions. Although minimally invasive resection has been established for GISTs, it is still considered unfeasible when tumors are near the esophagogastric junction. This study aimed to compare the relative efficacy of gasless laparoscopy-assisted (GLA) and open approaches for resection of GISTs.

PATIENTS AND METHODS

Between January 2006 and December 2008, 28 consecutive patients undergoing surgery for upper GIST were reviewed retrospectively. Among these patients, 15 underwent GLA procedures and 13 underwent open surgeries.

RESULTS

Patient demographics, comorbidities, and tumor characteristics (mean tumor size and prognosis) were similar for both groups. All patients underwent wedge resection. The mean operating time (129.6 versus 110.8 minutes), mean estimated blood loss (35.5 versus 40.3 mL), mean day of first flatus (2.7 versus 3.2 days), mean tumor size (2.5 versus 2.6 cm), and tumor prognosis or complication rate (13.3% versus 7.7%) between the GLA and open surgery groups were not significantly different. The length of maximal wound (P < 0.001), visual analog scale on postoperative days 1 (P = 0.001), 2 (P = 0.001), and 3 (P = 0.001), the mean time for resuming oral intake (P = 0.028), and the length of hospital stay (P = 0.005) in the GLA group were significantly lesser than the corresponding values in the open surgery group. None of the patients had dysphagia or died.

CONCLUSIONS

GLA method is a safe and feasible procedure for resecting GISTs of the upper stomach. In addition, it offers better cosmetic results, less pain, and faster recovery.

Laparoscopic vs open resection of gastric stromal tumors

BACKGROUND

Gastric stromal tumors are rare neoplasms that may be benign or malignant. Given that malignant gastric stromal tumors rarely involve lymph nodes and require excision with negative margins, they appear amendable to laparoscopic excision. There are few reports of laparoscopic resection, and no comparisons have been done between laparoscopic and open surgery. This study compares the relative efficacy of the two approaches.

METHODS

Between May 1994 and December 2000, 33 patients underwent 35 operations for gastric stromal tumors. Laparoscopic resections were performed in 21 patients; open resections were done in 12 patients. The medical records of the patients were reviewed retrospectively with regard to operating time, blood loss, length of stay, and clinical course.

RESULTS

Patient demographics, tumor characteristics (mean tumor size, benign vs malignant), and presenting symptoms were similar for both groups. In the laparoscopic group, 15 wedge resections; three partial gastrectomies, and three transgastric needlescopic enucleations were performed. In the open group, six wedge resections, four antrectomies, and two partial proximal gastrectomies were performed. There were no significant differences in mean operative time (169 vs 160 min), mean estimated blood loss (106 vs 129 cc), or perioperative complication rate (9.5% vs 8.3%) between the laparoscopic and open groups, respectively. The mean length of stay was significantly less (p<0.05) in the laparoscopic group (3.8 vs 6.2 days). Average follow-up was 1.5 years. One patient in each group has died due to metastatic disease. There have been no trocar site recurrences.

CONCLUSIONS

Laparoscopic resection of gastric stromal tumors is safe and appropriate. Tumor size, operating time, and estimated blood loss were equivalent to the open approach, and there was a statistically shorter hospital stay in the laparoscopic group.