The Value of Endoscopic Ultrasonography in the Endoscopic Resection of Gastrointestinal Stromal Tumors

Figures & data

Figure 1 Endoscopic and endoscopic ultrasonography for gastrointestinal stromal tumor. (A) A submucosal tumor was detected in the gastric fundus by general gastroscopy. (B) Endoscopic ultrasonography showed that the lesion originated from the muscularis propria, was hypoechoic, and had a non-homogeneous echo and visible echo-free area; Doppler ultrasound did not identify blood flow; cross-section size: 2.0 cm * 2.5 cm.

Table 1 Comparison of Five Surgical Methods for Gastric Stromal Tumors

Surgical Methods	Complete Resection Rate (%)	Hemorrhage During Operation [n(%)]	Perforation During Operation [n(%)]	Postoperative Complications [n(%)]
				Coagulation Syndrome	Perforation	Bleeding
EBL	7/9 (77.8)	0 (0)	3 (33.3)	0 (0)	0 (0)	0 (0)
ESD	36/37 (97.3)	0 (0)	6 (16.2)	2 (5.4)	1 (2.7)	0 (0)
ESE	27/27 (100)	2 (7.4)	4 (14.8)	2 (7.4)	0 (0)	0 (0)
EFTR	15/15 (100)	0 (0)	-*	3 (20.0)	0 (0)	0 (0)
STER	4/4 (100)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)

Note: *Perforation in EFTR were not included.

Abbreviations: EBL, endoscopic band ligation; ESD, endoscopic submucosal dissection; ESE, endoscopic submucosal excavation; EFTR, endoscopic full-thickness resection; STER, submucosal tunneling endoscopic resection.

Figure 2 Complete endoscopic full-thickness resection of tumor; clips combined with purse-string suture closure of wounds.

Table 2 Modified NIH Classification System Proposed by Joensuu

Class of Risk	Tumor Size (cm)	Mitotic Index (/50HPFs)	Primary Tumor Location
Extremely low risk	<2.0	<5	Any
Low risk	2.0–5.0	<5	Any
Moderate risk	<5.0	6–10	Gastric
	5.1–10.0	<5	Gastric
High risk	Any	Any	Tumor rupture
	>10.0	Any	Any
	Any	>10	Any
	>5.0	>5	Any
	≤5.0	>5	Non-gastric
	2.1–10.0	≤5	Non-gastric

Abbreviations: NIH, National Institutes of Health; HPF, high-power field.

Figure 3 Electron microscope (× 40 [A], × 100 [B], × 200 [C]), hematoxylin and eosin staining of cross-sectioned gastrointestinal stromal tumor; spindle cells and mitotic figures can be seen.

Figure 4 Immunohistochemical staining of gastrointestinal stromal tumor with DOG1 (A), CD117 (B), CD34 (C).

Table 3 Analysis of Ultrasound and General Endoscopic Features of Differentiated Gradient Stromal Tumors at Different Risks

		Extremely Low Risk	Low Risk	Moderate Risk	High Risk	χ^2	P
Average diameter	Eus	1.2	2.3	3.8	4.0		<0.001
	Pathological specimens	1.1	2.4	3.4	3.9		<0.001
Whether the echo was homogeneous [n(%)]						55.998	0.000
Homogeneous echo		61 (56.5)	9 (8.3)	0 (0)	0 (0)
Non-homogeneous echo		10 (9.3)	7 (6.5)	13 (12.0)	8 (7.4)
Types of the echo [n(%)]						6.829	0.337
Low echo		70 (64.8)	15 (14.0)	13 (12.0)	8 (7.4)
Iso-echo		0 (0)	1 (0.9)	0 (0)	0 (0)
High echo		1 (0.9)	0 (0)	0 (0)	0 (0)
Calcification [n(%)]						3.507	0.320
Yes		4 (3.7)	3 (2.8)	2 (1.9)	1 (0.9)
No		67 (62.0)	13 (12.0)	11 (10.2)	7 (6.5)
Blood flow signals [n(%)]						3.807	0.283
Yes		3 (2.8)	2 (1.9)	2 (1.9)	0 (0)
No		68 (62.9)	14 (12.9)	11 (10.2)	8 (7.4)
Liquid anechoic [n(%)]						83.825	0.000
Yes		0 (0)	1 (0.9)	11 (10.2)	7 (6.5)
No		71 (65.6)	15 (14.0)	2 (1.9)	1 (0.9)
Location [n(%)]						25.714	0.012
Fundus of stomach		43 (39.8)	6 (5.5)	4 (3.7)	4 (3.7)
Gastric body		12 (11.1)	4 (3.7)	5 (4.6)	3 (2.8)
Gastric fundus junction		11 (10.2)	4 (3.7)	0 (0)	0 (0)
Gastric antrum		2 (1.9)	2 (1.9)	0 (0)	0 (0)
Cardia and subcardia		3 (2.8)	0 (0)	4 (3.7)	1 (0.9)
Tumor surface characteristics [n(%)]
Hyperemia and edema		4 (3.7)	1 (0.9)	1 (0.9)	1 (0.9)		0.526
Congestion and erosion		1 (0.9)	2 (1.9)	4(3.7)	5 (4.6)		0.000
Apical depression		1 (0.9)	0 (0)	2 (1.9)	0 (0)		0.125

Abbreviation: EUS, endoscopic ultrasonography.