Zhou Pinghong, Zhong Yunshi, Li Quanlin
Surgical Section of Chinese Society of Digestive Endoscopology; Chinese Physicians Association Endoscope Branch Digestive Endoscopy Professional Committee; Gastrointestinal Surgery Section of Chinese Society of Surgery.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Aug 25;21(8):841-852.
The Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumors is the first guideline in the area of gastrointestinal submucosal tumors(SMT) in China. SMTs of the Gastrointestinal tract are bulge lesions that originate from muscularis mucosa, submucosa, or muscularis propria. Endoscopic treatment of SMT is an effective way to improve the quality of life for patients, to reduce the burden on patients' families and the society, and to save national medical resources. For these reasons, this consensus has proposed the indications for endoscopic resection, on the basis of current status of diagnosis and treatment for SMT in China, and in combination with domestic and foreign literature and experts' experience:(1)For tumors with malignant potential suspected by preoperative examination or pathologically confirmed through biopsy, endoscopic resection should be considered when technically possible; (2) Endoscopic resection is indicated for SMT with symptoms (e.g. hemorrhage and obstruction); (3) For benign tumors suspected by preoperative examinations or confirmed by pathological examination, endoscopic resection could be considered when patients cannot attend regular follow-up, tumors grow rapidly in a short period or patients have a strong willing for endoscopic treatment. After endoscopic resection for SMT, different treatment algorithms should be recommended according to pathological types:(1)For benign lesions, such as lipoma and leiomyoma, postoperative routine treatment and follow-up are recommended;(2)For SMT without malignant potential, such as well-differentiated rectal neruoendocrine tumors (NET) that are < 1 cm, survival rate after complete resection is approximately 98.9%-100% and the recurrence rate is extremely low. Therefore, routine follow-up is recommended when the margin were confirmed negative pathologically; (3)Low-malignant-potential SMT, such as low-risk GIST, should be assessed by endoscopic ultrasonography or imaging every 6-12 months, and then managed according to clinical instructions; (4)Medium/high-malignant-potential SMT, such as type 3 and type 4 gastric NET, colorectal NET that are >2 cm, and medium/high-risk GISTs, additional treatment is required according to the guidelines for each specific disease. This expert consensus aims to provide an endoscopic SMT diagnosis and treatment standard,which fits our current national status, to domestic hospitals at all levels.
《中国胃肠道黏膜下肿瘤内镜诊断与治疗共识》是我国胃肠道黏膜下肿瘤（SMT）领域的首部指南。胃肠道SMT是起源于黏膜肌层、黏膜下层或固有肌层的隆起性病变。内镜治疗SMT是提高患者生活质量、减轻患者家庭及社会负担、节约国家医疗资源的有效途径。基于上述原因，本共识结合我国SMT诊治现状，参考国内外文献并借鉴专家经验，提出了内镜切除的适应证：（1）术前检查怀疑有恶变潜能或活检病理确诊为恶性的肿瘤，若技术可行应考虑内镜切除；（2）有症状（如出血、梗阻）的SMT可行内镜切除；（3）术前检查怀疑为良性或病理检查确诊为良性的肿瘤，若患者无法定期随访、肿瘤短期内迅速生长或患者有强烈的内镜治疗意愿，可考虑内镜切除。SMT内镜切除术后，应根据病理类型推荐不同的治疗方案：（1）对于脂肪瘤、平滑肌瘤等良性病变，建议术后进行常规治疗及随访；（2）对于无恶变潜能的SMT，如直径<1 cm的高分化直肠神经内分泌肿瘤（NET），完整切除后的生存率约为98.9% - 100%，复发率极低。因此，病理切缘阴性时建议常规随访；（3）低恶变潜能的SMT，如低风险胃肠道间质瘤（GIST），应每6 - 12个月行超声内镜或影像学评估，然后根据临床指导进行处理；（4）中/高恶变潜能的SMT，如3型和4型胃NET、直径>2 cm的结直肠NET以及中/高风险GIST，需根据各具体疾病的指南进行进一步治疗。本专家共识旨在为国内各级医院提供符合我国国情的SMT内镜诊断与治疗标准。
