scholarly journals GIST and Ghrelin: To Be or Not to Be?

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1361
Author(s):  
Irene Alexandra Spiridon ◽  
Delia Gabriela Apostol Ciobanu ◽  
Simona Eliza Giușcă ◽  
Dan Ferariu ◽  
Iulia Cătălina Pleşca ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Study Design ◽  
Gastrointestinal Stromal Tumors ◽  
Immunohistochemical Expression ◽  
Tissue Samples ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
H Pylori

Background: Ghrelin is the orexigenic hormone secreted mainly by the stomach. Its involvement in neoplastic development has been studied in gastrointestinal adenocarcinomas. Our paper aims to evaluate the influence of the ghrelin axis in gastrointestinal stromal tumors (GISTs). Materials and Methods: The study design included two groups of patients, 46 with gastric GISTs and 30 with obesity. Archived tissue samples were evaluated for the presence of gastritis and H. pylori. Immunohistochemical expression of ghrelin and its receptor (GHS-R) was assessed. Results: All GISTs showed absent immunohistochemical expression for ghrelin, while GHS-R displayed a particular pattern, with notable differences in intensity (p = 0.0256) and percentage of stained cells (p < 0.00001) in the periphery vs. core of tumors. Positive ghrelin expression was lower in the gastric mucosa of the first group compared to the second group (p < 0.001). Conclusion: The ghrelin axis can influence GISTs carcinogenesis through activation of GHS-R. A previously described direct autocrine/paracrine mechanism is not supported by our findings.

scholarly journals Endoscopic Removal of Gastrointestinal Stromal Tumors in the Stomach: A Single-Center Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Yingjie Guo ◽  
Xue Jing ◽  
Jian Zhang ◽  
Xueli Ding ◽  
Xiaoyu Li ◽  
...  
Keyword(s):  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Average Length ◽  
Risk Classification ◽  
Low Risk ◽  
Efficacy And Safety ◽  
Endoscopic Removal ◽  
Moderate Risk ◽  
Stromal Tumors ◽  
Gastric Gists

Background and Aims. Endoscopic removal of GISTs (gastrointestinal stromal tumors) is recently recognized, but less is known about its efficacy and safety. This study is aimed at assessing the feasibility, clinical efficacy, and safety of the endoscopic removal of gastric GISTs. Patients and Methods. Endoscopic removal (ER) of GISTs was performed in 134 patients at our hospital between January 2015 and January 2019. The clinical features, surgical outcomes, complications, pathological diagnosis, and risk classification were evaluated retrospectively. Results. ER was successful in 131 cases (98%), including 58 by ESD (endoscopic submucosal dissection), 43 by ESE (endoscopic submucosal excavation), 25 by EFTR (endoscopic full-thickness resection), and 5 by STER (submucosal tunneling endoscopic resection). In addition, GISTs of two cases were resected using LECS (laparoscopic and luminal endoscopic cooperative surgery) for the extraluminal and intraluminal growth pattern. The average tumor size was 1.89±1.25 cm (range: 0.5-6.0 cm). Of these patients, 26 cases had a large tumor size (range: 2.0-6.0 cm), and endoscopic removal was successful in all of them. During the procedure, endoclips were used to close the perforation in all cases, without conversion to open surgery. The average length of hospital stay was 5.50±2.15 days (range: 3-10 days). In the risk classification, 106 (79.7%) were of a very low risk, 25 (18.8%) of a low risk, and 2 (1.5%) of a moderate risk. The moderate-risk cases were treated with imatinib mesylate after ER. No recurrence or metastasis was observed during the follow-up period of 23±8 months (range: 3-48 months). Conclusions. The endoscopic treatment is feasible, effective, and safe for gastric GISTs, and individualized choice of approaches is recommended for GISTs.

Outcomes of multivisceral resection of gastric gastrointestinal stromal tumors.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 91-91
Author(s):  
Sabha Ganai ◽  
Mitchell Posner ◽  
Vivek N. Prachand ◽  
John C. Alverdy ◽  
Eugene A. Choi ◽  
...  
Keyword(s):  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Disease Free Survival ◽  
Multivisceral Resection ◽  
Response To Therapy ◽  
Hospital Length Of Stay ◽  
Free Survival ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Disease Free

91 Background: Despite the recent introduction of imatinib and laparoendoscopic techniques to the management of gastric gastrointestinal stromal tumors (GISTs), outcomes remain uncertain in the setting of multivisceral involvement. Methods: We conducted a retrospective review of 69 consecutive patients who underwent resection of gastric GISTs from October 2002 through August 2011. Median follow-up was 19 months (interquartile range [IQR] 4-37). Results: Patients were 51% female, with a mean age of 65 ± 13 years and BMI of 30 ± 8 kg/m2. Patients undergoing multivisceral resection (n=13) had a longer interval from diagnosis to surgery (7.4 [IQR 1.9 – 15.0] vs. 1.3 [IQR 0.7-3.5] months, p<0.01), greater use of neoadjuvant imatinib (62% vs. 4%, p<0.001), and greater preoperative tumor size (12 ± 8 vs. 4 ± 3 cm, p<0.001) in comparison to gastric-only resections (n=56). Patients were less likely to be managed laparoscopically (8% vs. 71%, p<0.001), had a longer operative time (286 ± 92 vs. 152 ± 65 min, p<0.001), and were less likely to be R0 (69% vs. 98%, p<0.001). While patients undergoing multivisceral resection were more likely to have a pathological complete response to therapy (23% vs. 0, p<0.01), they were also more likely to have metastatic disease present (31% vs. 0, p<0.01). Hospital length of stay was greater (median 8 [IQR 7-9] vs. 3 [IQR 2-6] days, p<0.001). There were no significant differences in grade or mitotic index between groups, or in the use of adjuvant imatinib (54% vs. 23%). Overall survival was less in patients undergoing multivisceral resection (63% vs. 86% at 3 years, p<0.05), as was disease-free survival (52% vs. 71% at 3 years, p<0.05). Median disease-free survival was 50 and 66 months, respectively (p<0.01). Controlling for tumor size, grade, resection status, and the use of neoadjuvant imatinib, multivisceral resection was an independent predictor of disease-free survival (p<0.05). Conclusions: Multivisceral involvement is associated with tumors of greater size, and despite an increased use of neoadjuvant imatinib, it is associated with poor outcome for patients with gastric GISTs.

Gastrointestinal Stromal Tumor Outcomes

2017 ◽  
Author(s):  
Monica Jain
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Study Design ◽  
Gastrointestinal Stromal Tumors ◽  
Surgical Oncology ◽  
Disease Recurrence ◽  
Clinical Vignette ◽  
Stromal Tumors ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of the landmark study in surgical oncology. What characteristics of gastrointestinal stromal tumors (GIST) predict survival and disease recurrence? Starting with this question, the chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses the implications, and concludes with a clinical vignette to display how the study’s findings can be clinically applied to a sample patient.

scholarly journals Status of the Gastric Mucosa with Endoscopically Diagnosed Gastrointestinal Stromal Tumor

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Kouichi Nonaka ◽  
Shinichi Ban ◽  
Yoshimitsu Hiejima ◽  
Rei Narita ◽  
Michio Shimizu ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Gastrointestinal Stromal Tumor ◽  
Submucosal Tumor ◽  
Stromal Tumor ◽  
Upper Gastrointestinal Endoscopy ◽  
Submucosal Tumors ◽  
Gastric Gists ◽  
Mri Features ◽  
H Pylori ◽  
Ct And Mri

Background. Since gastrointestinal stromal tumor (GIST) is a mesenchymal submucosal tumor, the endosonographic, CT, and MRI features of gastric GISTs have been widely investigated. However, the GIST-bearing gastric mucosa status has not been reported. Objective. To characterize the GIST-bearing gastric mucosa status in terms of the degree of inflammation and atrophy, assessed endoscopically. Subjects and Methods. The subjects were 46 patients with submucosal tumors (histologically proven gastric GISTs) who had undergone upper gastrointestinal endoscopy in our hospital between April 2007 and September 2012. They were retrospectively evaluated regarding clinicopathological features, the endoscopically determined status of the entire gastric mucosa (presence or absence and degree of atrophy), presence or absence and severity of endoscopic gastritis/atrophy (A-B classification) at the GIST site, and presence or absence of H. pylori infection. Results. Twenty-three patients had no mucosal atrophy, but 17 and 6 had closed- and open-type atrophy, respectively. Twenty-six, 5, 12, 1, 1, and 1 patients had grades B0, B1, B2, B3, A0, and A1 gastritis/atrophy at the lesion site, respectively, with no grade A2 gastritis/atrophy. Conclusion. The results suggest that gastric GISTs tend to arise in the stomach wall with H. pylori-negative, nonatrophic mucosa or H. pylori-positive, mildly atrophic mucosa.

scholarly journals Hybrid Push-Pull Endoscopic and Laparoscopic Full Thickness Resection for the Minimally Invasive Management of Gastrointestinal Stromal Tumors: A Pilot Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Field F. Willingham ◽  
Paul Reynolds ◽  
Melinda Lewis ◽  
Andrew Ross ◽  
Shishir K. Maithel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Resection ◽  
Gastrointestinal Stromal Tumors ◽  
Wedge Resection ◽  
Tertiary Care ◽  
R0 Resection ◽  
Full Thickness ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Deep Margin

Background. Gastric gastrointestinal stromal tumors (GISTs) that are predominantly endophytic or in anatomically complex locations pose a challenge for laparoscopic wedge resection; however, endoscopic resection can be associated with a positive deep margin given the fourth-layer origin of the tumors.Methods. Patients at two tertiary care academic medical centers with gastric GISTs in difficult anatomic locations or with a predominant endophytic component were considered for enrollment. Preoperative esophagogastroduodenoscopy (EGD), endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA), and cross-sectional imaging were performed. Eligible patients were offered and consented for hybrid and standard management.Results. Over ten months, four patients in two institutions with anatomically complex or endophytic GISTs underwent successful, uncomplicated push-pull hybrid procedures. GIST was confirmed in all resection specimens.Conclusion. In a highly selected population, the hybrid push-pull approach was safe and effective in the removal of complex gastric GISTs. Endoscopic resection alone was associated with a positive deep margin, which the push-pull technique manages with a laparoscopic, full thickness, R0 resection. This novel, minimally invasive, hybrid laparoscopic and endoscopic push-pull technique is a safe and feasible alternative in the management of select GISTs that are not amenable to standard laparoscopic resection.

scholarly journals Clinical feasibility and safety of third space robotic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumors dissection

2019 ◽  
Vol 33 (12) ◽  
pp. 4192-4200
Author(s):  
Feiyu Shi ◽  
Yingchao Li ◽  
Yanglin Pan ◽  
Qi Sun ◽  
Guanghui Wang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Gastrointestinal Stromal Tumors ◽  
Third Space ◽  
Operation Time ◽  
R0 Resection ◽  
Gastric Gist ◽  
Minimal Invasiveness ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Mucosal Layer

Abstract Background Surgical management of gastric gastrointestinal stromal tumors (GISTs) has evolved towards minimal invasiveness. Laparoscopic wedge resection and laparoscopic and endoscopic cooperative surgery had been considered as standard surgical treatments for gastric GISTs > 2 cm. However, stomach deformation and the full-thickness gastric defect caused by these procedures may increase the risk of morbidity. To address these problems, we developed a novel technique, third space robotic and endoscopic cooperative surgery (TS-RECS), which could dissect the tumor entirely while preserving the intact mucosal layer. Here we performed a prospective evaluation of the feasibility and safety of TS-RECS. Methods Patients with gastric GISTs were recruited between April 2018 and April 2019. During the operation, the gastric GIST was located by endoscopic view firstly and the submucosal injection was performed. The tumor was then dissected through robotic surgery. Clinicopathological characteristics, operative data, adverse events, and follow-ups were prospectively collected and analyzed. Results A total of 20 patients with gastric GISTs received TS-RECS. The mean tumor size was 33.0 ± 7.3 mm. R0 resection was achieved in all patients with a median operation time of 115 min and a median blood loss of 20 ml. The integrity of mucosal layer was maintained in 95% (19/20) of the patients. All patients started oral diet on postoperative day 1 or 2, staying in the hospital for a median of 6 days after surgery. There were no major adverse events. Local or distant recurrences were not observed during a median follow-up period of 10 months. Conclusions Our study suggests that TS-RECS appears to be a feasible and safe technique which could be an alternative method for resecting gastric GISTs > 2 cm. Clinical Trials ClinicalTrials.gov NCT03804762.

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