Endoscopic Full Thickness Resection compared to Submucosal Tunnel Endoscopic Resection for Treatment of Gastric Gastrointestinal Stromal Tumor

Introduction Submucosal tunnel endoscopic resections (STER) had been increasingly performed for treatment of gastric GIST, while STER was limited by close dissection within tunnel and risking breach of tumor capsule. Endoscopic full thickness resection (EFTR) allowed resection of GIST with margins to prevent recurrence. This study aimed to compare EFTR against STER for treatment of gastric GIST. Method We retrospectively reviewed clinical outcomes of patients with gastric GIST who received either STER or EFTR. Gastric GIST less than 4cm were recruited. The clinical outcomes including baseline demographics, perioperative and oncological outcomes were compared between two groups. Results From 2013 to 2019, 46 patients with gastric GIST were treated by endoscopic resection, 26 received EFTR and 20 received STER. Most of the GISTs were in proximal stomach. There was no difference in operative time (94.9 vs 84.9 mins; p = 0.401), while endoscopic suturing was applied more for closure after EFTR (p < 0.0001). Patients after STER had earlier resumption of diet and shorter hospital stay while there was no difference in adverse event rate between two groups. The en-bloc resection rate for EFTR was significantly higher than STER (100% vs 80%; p = 0.029) while there was no difference in the local recurrence. Conclusion This study demonstrated that although patients who received EFTR had longer hospital stay and slower resumption of diet compared to STER, EFTR achieved significantly higher rate of en-bloc resection compared to STER for treatment of gastric GIST.