Endoscopic band ligation versus endoscopic submucosal dissection and laparoscopic resection for small gastric stromal tumors.

ABSTRACT

BACKGROUND AND AIM: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Previous studies have addressed the safety and feasibility of endoscopic band ligation (EBL) for the treatment of small gastric GISTs. However, published reports comparing EBL with other interventions are limited. This current study evaluates the efficacy of EBL and compares EBL to both endoscopic submucosal dissection (ESD) and laparoscopic resection (LAP) for small gastric GISTs less than 15 mm. METHODS: A total of 339 patients who underwent endoscopic therapy or laparoscopic resection for gastric GISTs between 1998 and 2012 were retrospectively identified and collected from medical records in our hospital. The parameters measured for each procedure type includes clinicopathological characteristics, length of stay, hospitalization expense and surgical outcomes. RESULTS: Among the 147 patients included in our study, 72 (48.98 %) received EBL, 27 (18.37 %) received ESD, and 48 (32.65 %) received LAP. The demographic and clinical characteristics of the patients such as gender, age, tumor site and size were well balanced between the study groups. There was also no significant difference in follow-up time between the study groups. The mean operating time was significantly shorter in the patients receiving EBL than patients receiving ESD and LAP (p < 0.001). The estimated blood loss was significantly different between the three groups (p < 0.001). Complications occurred in 1.39 % of the patients receiving EBL, 18.52 % of the patients receiving ESD and 4.17 % of the patients receiving LAP (p = 0.004), and recurrence rate in 15.00, 9.10 and 11.76 %, respectively (p = 0.705). There was also significant difference about mean hospital stay and hospital cost between three groups (p < 0.001). CONCLUSION: Our results show a significant advantage in the short-term outcome for EBL compared to ESD and LAP. However, long-term randomized controlled trials are needed to compare the three methods for the treatment of small GISTs.