Luo Shao-Bin, Liu Zu-Qiang, Wang Li, Zhang Yi-Qun, Cai Ming-Yan, Li Quan-Lin, Zhou Ping-Hong
Endoscopy Center and Edoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China.
Endosc Int Open. 2025 Aug 7;13:a26551439. doi: 10.1055/a-2655-1439. eCollection 2025.
Endoscopic resection for duodenal gastrointestinal stromal tumors (GISTs) is still considered a great challenge with a high risk of complications. This study aimed to evaluate effectiveness and safety of endoscopic resection for duodenal GIST.
Between June 2013 and August 2024, we performed a retrospective study of patients with duodenal GISTs who underwent endoscopic resection at Zhongshan Hospital. Data on patient characteristics, clinical outcome, and follow-up were collected.
A total of 73 patients with duodenal GISTs were enrolled, including 31 patients who underwent endoscopic submucosal dissection (ESD) and 42 who underwent endoscopic full-thickness resection (EFTR). Mean lesion size was 1.2 ± 0.5 cm and 1.9 ± 0.9 cm, respectively. En bloc resection rates were 96.8% and 95.2%, respectively. Rates of R0 resection were 45.2% and 42.9%, respectively. Rates of R1 resection were 54.8% and 57.1%, respectively. No patient transferred to open surgery. Postoperative adverse events included delayed bleeding (1 case), delayed perforation (1 case), delayed wall edema (2 cases), hydrothorax (1 case), and retroperitoneal infection (1 case). Mean hospital stays were 4.1 ± 2.8 days and 6.2 ± 4.9 days, respectively. No metastasis or duodenal stenosis were detected during the follow-up period (64.8 ± 43.6 months and 61.3 ± 40.2 months, respectively). Local recurrence occurred in one patient with high recurrence risk at 56 months after EFTR.
ESD and EFTR are safe, minimally invasive treatments for duodenal GISTs. Moreover, the EFTR technique may have advantages of completely resecting lesions originating from the deep muscularis propria layer, particularly lesions with extraluminal growth.
十二指肠胃肠道间质瘤（GIST）的内镜切除仍被认为是一项极具挑战性的操作，并发症风险较高。本研究旨在评估十二指肠GIST内镜切除的有效性和安全性。
2013年6月至2024年8月期间，我们对在中山医院接受内镜切除的十二指肠GIST患者进行了一项回顾性研究。收集了患者特征、临床结局及随访数据。
共纳入73例十二指肠GIST患者，其中31例行内镜黏膜下剥离术（ESD），42例行内镜全层切除术（EFTR）。病变平均大小分别为1.2±0.5cm和1.9±0.9cm。整块切除率分别为96.8%和95.2%。R0切除率分别为45.2%和42.9%。R1切除率分别为54.8%和57.1%。无患者转为开放手术。术后不良事件包括迟发性出血（1例）、迟发性穿孔（1例）、迟发性壁水肿（2例）、胸腔积液（1例）和腹膜后感染（1例）。平均住院时间分别为4.1±2.8天和6.2±4.9天。随访期间（分别为64.8±43.6个月和61.3±40.2个月）未检测到转移或十二指肠狭窄。1例高复发风险患者在EFTR术后56个月出现局部复发。
ESD和EFTR是治疗十二指肠GIST安全、微创的方法。此外，EFTR技术可能具有完全切除起源于固有肌层深层的病变的优势，尤其是具有腔外生长的病变。
