scholarly journals The Incidence of Gastrointestinal Stromal Tumors in Obese Patients—A Large Single Center Experience

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1242
Author(s):  
Natalia Dowgiałło-Gornowicz ◽  
Klaudia Sztaba ◽  
Paweł Lech ◽  
Anna Botulińska ◽  
Maciej Michalik
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Histopathological Examination ◽  
Low Risk ◽  
Risk Category ◽  
Morbidly Obese ◽  
Resected Stomach ◽  
Obese Patients ◽  
Preoperative Body Mass Index ◽  
Stromal Tumors ◽  
The Mean

Background and Objectives: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms located mainly in the fundus (60–70%). The incidence of GIST is approximately 10 per million population per year in Europe, with a peak incidence at the age of 63. Recent studies suggest that morbidly obese patients have a higher incidence of GIST than the general population. The aim of this study was to analyze the incidence of GIST in patients undergoing laparoscopic sleeve gastrectomy (LSG) in our department. Materials and Methods: this paper present the retrospective study of prospectively collected data of 1564 patients who underwent LSG in a single large bariatric center from October 2013 to September 2021. After surgery, each sample of the resected stomach was sent for histopathological examination. For the analysis, we included patients diagnosed with GIST intraoperatively or postoperatively. Results: GISTs were found in five patients (0.31%). There were three men and two women. The mean age was 50.2 (range 32–63 ± 11.8) and the mean preoperative body mass index was 43.3 kg/m2 (40–49.4 ± 3.2). In four cases, GISTs were found in the fundus (80%), and in one in the pylorus (20%). None of the tumors were larger than 7 mm in diameter and all were diagnosed as a very low-risk category. No adjuvant treatment was required. All patients achieved good or satisfactory bariatric and metabolic results. Conclusions: The incidence of GIST in our study was estimated at 0.31%. All patients had a very low-risk GIST and no recurrence until follow-up. Recent literature suggests that the risk of GIST is higher in the obese population, and therefore surgeons should be aware of the risk of incidental GIST during LSG.

scholarly journals Gastrointestinal Stromal Tumors—A Mini Review

2021 ◽  
Vol 11 (8) ◽  
pp. 694
Author(s):  
Gina Gheorghe ◽  
Nicolae Bacalbasa ◽  
Gabriela Ceobanu ◽  
Madalina Ilie ◽  
Valentin Enache ◽  
...  
Keyword(s):  
Digestive Tract ◽  
Gastrointestinal Stromal Tumors ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Growth Factor Receptor ◽  
Risk Category ◽  
Genetic Syndromes ◽  
Stromal Tumors ◽  
Factor Receptor Alpha ◽  
Potentially Malignant

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. They are potentially malignant, and have an unpredictable evolution. The origin of these tumors is in the interstitial cells of Cajal, which are cells that are interposed between the intramural neurons and the smooth muscle cells of the digestive tract. GISTs are characterized by mutations in the gene c-Kit, but also other mutations, such as those of the platelet-derived growth factor receptor alpha. The most common locations of these tumors are the stomach and small intestine, although they can occur at any level of the digestive tract and occasionally in the omentum, mesentery and peritoneum. Most cases of GISTs are sporadic, and about 5% of cases are part of family genetic syndromes. The correct diagnosis of GIST is determined by histopathological examination and immunohistochemistry. According to histopathology, there are three main types of GISTs: spindle cell type, epithelioid type and mixed type. The therapeutic management of GIST includes surgery, endoscopic treatment and chemotherapy. The prognosis of patients with GIST varies depending on a number of factors, such as risk category, GIST stage, treatment applied and recurrence after treatment.

scholarly journals Histopathological Characteristics of Gastrointestinal Stromal Tumors in a Cohort of Vietnamese Patients

2020 ◽  
Vol 13 ◽  
pp. 2632010X2097240
Author(s):  
Pham Nguyen Cuong ◽  
Nguyen Thanh Xuan ◽  
Tran Xuan Tien ◽  
Pham Nhu Huy ◽  
Pham Nguyen Tuong
Keyword(s):  
High Risk ◽  
Gastrointestinal Stromal Tumors ◽  
Histopathological Examination ◽  
Armed Forces ◽  
Risk Groups ◽  
Low Risk ◽  
Stromal Tumors ◽  
Primary Gist ◽  
Mesenchymal Neoplasms ◽  
The Relationship

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal system. Histopathological examination takes an important part in confirming the subtypes of GISTs, to choose appropriate therapeutics for patients. This study aims to explore the histopathological characteristics and evaluate the relationship between malignant risk classification (according to Armed Forces Institute of Pathology criteria) and the histopathological features of GISTs in a cohort of Vietnamese patients. Methods: We reviewed 89 patients with primary GIST who underwent surgery between 2014 and 2019 at Hue Central Hospital, Vietnam. We investigated histopathological characteristics and immunohistochemical findings of all patients. Results: The average age was 55.9 ± 11.9 years. A tumor size of 2-5 cm accounted for 64.1%. The most common position was at the stomach which accounted for 48.5%. Among the subtypes of GIST, spindle cells were seen in 85.9% of patients; epithelial form 10.9%; multi-morphology (3.2%). 97.4% of the samples were positive for CD117, 61.5% of cases were positive for CD34; and no case was positive for Desmin. The rate of high-risk GIST was dominant (46.9%) as compared to the intermediate-risk (28.1%), low-risk (0.3%-2%), and very low-risk groups (4.7%). Conclusions: This study demonstrates the histopathological characteristics of GIST and emphasizes the significant rate of high-risk GIST.

scholarly journals Second Primary Tumors in Patients with Gastrointestinal Stromal Tumors: A Single-Center Experience

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 494
Author(s):  
Murat Koçer ◽  
Sadık Muallaoğlu ◽  
Bülent Çetin ◽  
Hasan Şenol Coşkun ◽  
Nermin Karahan ◽  
...  
Keyword(s):  
Survival Data ◽  
Gastrointestinal Stromal Tumors ◽  
Low Risk ◽  
Gastrointestinal System ◽  
Second Primary ◽  
Single Center ◽  
Primary Tumors ◽  
Stromal Tumors ◽  
The Mean

Background and Objectives: In this study, we investigated the frequency and type of second primary malignant tumors (SPMTs) accompanying gastrointestinal stromal tumors (GISTs), patient and tumor characteristics, and follow-up and survival data. Materials and Methods: We included 20 patients with SPMTs from a total of 103 patients with GISTs in a single center in Turkey. At the time of GIST diagnosis, patient age, sex, presentation symptoms, localization, pathological features of the tumor, stage, recurrence risk scoring for localized disease, treatments received, time of SPMT association, follow-up times, and survival analysis were recorded for each patient. Localization, histopathology, and stage of SPMT accompanying GISTs were also recorded accordingly. Results: SPMT was detected in 19.4% of patients with GISTs. Of the patients, 50% were men and 50% were women. The mean age at the time of diagnosis of GIST was 63.8 ± 10.81 years (range: 39–77 years). Of the GISTs, 60% were localized in the stomach, 25% in the small intestine, and 70% were at low risk. Of the SPMTs, 60% were in the gastrointestinal system. SPMTs were diagnosed as synchronous with GISTs in 50% of the patients. The mean follow-up period of the patients from the diagnosis of GIST was 45.6 (0.43–129.6) months. When the data were finalized, 5% died due to GIST, 35% died due to SPMT, and 15% died due to non-disease-related causes. Conclusions: SPMT was detected in 19.4% of patients with GISTs. GISTs were frequently located in the stomach, and most of them were at low risk. The most common SPMTs were gastrointestinal system tumors, and their coexistence was found to be synchronous. Most patients died due to SPMT during follow-up.

scholarly journals Relationship between FDG uptake and the pathological risk category in gastrointestinal stromal tumors

2010 ◽  
Vol 57 (3,4) ◽  
pp. 270-274 ◽  
Author(s):  
Yoichi Otomi ◽  
Hideki Otsuka ◽  
Naomi Morita ◽  
Kaori Terazawa ◽  
Kaori Furutani ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Risk Category ◽  
Stromal Tumors ◽  
Fdg Uptake

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.

scholarly journals Laparoscopic Ventral Hernia Repair Combined with Sleeve Gastrectomy in Morbidly Obese Patients: Early Outcomes

2019 ◽  
Vol 05 (03) ◽  
pp. e87-e91 ◽  
Author(s):  
Ahmed M.S.M. Marzouk ◽  
Heba O.E. Ali
Keyword(s):  
Sleeve Gastrectomy ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Mesh Size ◽  
Laparoscopic Ventral Hernia Repair ◽  
Abdominal Pressure ◽  
Morbidly Obese ◽  
Obese Patients ◽  
The Mean

Background Morbid obesity is a serious chronic condition with, among other symptoms, increased intra-abdominal pressure and subsequent abdominal wall hernias. The optimal management of these manifestations is still controversial. The objective of this study was to assess the early postoperative outcomes of a surgical approach combining laparoscopic ventral hernia repair (LVHR) with sleeve gastrectomy in morbidly obese patients. Methods In this retrospective study, we reviewed the files of patients who are obese with a primary ventral hernia of less than 10 cm in diameter who received simultaneous laparoscopic sleeve gastrectomy and LVHR at our institution between February 2016 and July 2018. LVHR was performed using an intraperitoneal only mesh. The individual mesh size was chosen based on the number and size of the defects. Clinical and radiological follow-ups were performed between 9 and 15 months. Results A total of 15 patients were included. Five of them were males. The mean body mass index was 45.2 kg/m2 (range: 38.7–56.2 kg/m2). The mean hernia defect size was 2.6 cm (range: 1.3–4.2 cm). Mesh size was 10 × 15 cm in five, 20 × 15 cm in seven, and 25 cm× 20 cm in three patients. All patients were discharged without complications on the second postoperative day. Mean follow-up was at 12 months. One patient presented with hernia recurrence 14 months after surgery and four patients presented with self-limited seroma. Conclusion Despite ambiguous guidelines and ongoing debate regarding simultaneous bariatric surgery and ventral hernia repair, the short-term outcomes of this approach appeared promising, provided that patients are carefully selected and receive an individually tailored approach.

Changes in imatinib plasma trough level during long-term treatment of patients with advanced gastrointestinal stromal tumors.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 306-306
Author(s):  
Y. Kang ◽  
C. Yoo ◽  
B. Ryoo ◽  
H. Chang ◽  
J. Lee ◽  
...  
Keyword(s):  
Plasma Level ◽  
Gastrointestinal Stromal Tumors ◽  
Plasma Concentrations ◽  
Term Treatment ◽  
Albumin Concentration ◽  
Stromal Tumors ◽  
Long Term Treatment ◽  
The Mean ◽  
Median Interval

306 Background: Pharmacokinetic study in patients with gastrointestinal stromal tumors (GISTs) suggested that plasma concentrations of imatinib decrease following long-term exposure. We therefore measured changes in imatinib plasma trough levels (Cmin) after long-term exposure. Methods: Between November 2009 and May 2010, follow-up (FU) imatinib Cmin was measured in 65 patients who received the same dose of imatinib for at least 9 months after a previous baseline (BL) measurement. Total 244 blood samples were obtained (127 at BL and 117 at FU) and plasma level was measured by liquid chromatography-tandem mass spectrometry. Results: Median patient age was 54 years (range, 28–76 years) and 42 (64.6%) patients were male. Sixty-one (93.8%) patients were treated with 400 mg/day imatinib and 4 (6.2%) with 300 mg/day. The median interval from initiation of imatinib to BL test was 6.4 months (range, 0.5–66.6 months), and the median interval between BL and FU test was 13.1 months (range, 9.6–18.4 months). The mean ± standard deviation imatinib Cmin was significantly higher at FU than at BL (1442 ± 693 ng/mL vs 1221 ± 624 ng/mL, p<0.001). The mean inter- and intra-subject variabilities were 49.2% and 25.5%, respectively, at BL, and 44.2% and 20.4%, respectively, at FU. Multivariate analysis showed a significant correlation between the ratio of FU to BL imatinib Cmin and that of albumin (r=-0.397, p=0.001). In per-sample analysis, imatinib Cmin was significantly correlated with age, hemoglobin, albumin, creatinine clearance, previous major gastrectomy and time between initiation of imatinib and plasma level tests. Conclusions: Steady-state imatinib Cmin did not decrease but remained stable in most GIST patients during long-term treatment. Changes in imatinib Cmin were associated with changes in albumin concentration. Monitoring of imatinib Cmin only for concerns about time-dependent decreases in imatinib exposure is not necessary. [Table: see text]

Various fashions of laparoscopic resection for gastrointestinal stromal tumors in esophagogastric junction.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22512-e22512
Author(s):  
Wenjun Xiong ◽  
Wei Wang ◽  
Jin Wan
Keyword(s):  
Laparoscopic Surgery ◽  
Gastrointestinal Stromal Tumors ◽  
Esophagogastric Junction ◽  
Laparoscopic Resection ◽  
Stomach Wall ◽  
Linear Stapler ◽  
Stromal Tumors ◽  
Estimated Blood Loss ◽  
Laparoscopic Proximal Gastrectomy ◽  
The Mean

e22512 Background: Laparoscopic surgery for small (<5 cm) gastric gastrointestinal stromal tumors (GIST) is now widely performed. However, laparoscopic resection of GIST in esophagogastric junction is technically difficult. Herein, we introduce various fashion of laparoscopic resection for small GIST in esophagogastric junction. Methods: Retrospective review of 40 consecutive patients with small GIST in esophagogastric junction who underwent attempted laparoscopic surgery. GIST in esophagogastric junction was defined as that the distance of the upper border of GIST from esophagogastric line was less than 2 cm. Three fashions of laparoscopic resection were performed: fashion A, laparoscopic wedge resection using linear stapler; fashion B, laparoscopic complete resection by opening the stomach wall and the stomach wall incision was closed with suture; fashion C, laparoscopic proximal gastrectomy with pyloroplasty. The data of clinicopathologic characteristics, operative course and short-term outcomes were analyzed. Results: All procedures were finished successfully and no operative relatively complication was recorded. Tumor in 24/40 (60%) patients was located in greater curvature. 70.1% (17/24) of them received fashion A and others (7/24) underwent fashion B. Tumor in 16/40 (40%) patients was located in lesser curvature. 18.8% (3/16) of them underwent fashion C and others (13/16) underwent fashion B. The mean operative time was 97.4±21.3 min and the mean estimated blood loss was 20.5±10.4 ml. The mean first time of flatus was 39.2±10.0 hours and the time of fluid intake was 40.1±11.7 hours. The mean hospital stay was 4.2±1.3 days. The mean diameter of tumor was 2.7±1.0 cm. Conclusions: Laparoscopic surgery for small GIST in esophagogastric junction is safe and feasible. The selection of various laparoscopic resection fashions was according to the tumor location.

Biological and clinical significance of cytogenetic abnormalities in low-risk and high-risk gastrointestinal stromal tumors

2002 ◽  
Vol 33 (3) ◽  
pp. 316-321 ◽  
Author(s):  
Bastian Gunawan ◽  
Frank Bergmann ◽  
Jörg Höer ◽  
Claus Langer ◽  
Volker Schumpelick ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Significance ◽  
Gastrointestinal Stromal Tumors ◽  
Low Risk ◽  
Cytogenetic Abnormalities ◽  
Stromal Tumors

scholarly journals 711 Effect of Roux-En-Y Gastric Bypass on HbA1c As Well As Number of Medications in Diabetic Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Bhandari ◽  
M Rao ◽  
G Bussa ◽  
C Rao
Keyword(s):  
Diabetes Mellitus ◽  
Gastric Bypass ◽  
Glycosylated Haemoglobin ◽  
Morbidly Obese ◽  
Diabetic Patients ◽  
Obese Patients ◽  
The Mean ◽  
The Impact

Abstract Aim Roux en Y gastric bypass (RYGB) is known to ameliorate Type 2 Diabetes Mellitus (T2DM) in morbidly obese patients. We aimed to determine both the reduction in the glycosylated haemoglobin (HbA1c) and the number of anti-diabetic medications (including insulin) in diabetic patients undergoing RYGB over a five-year period. Method We reviewed data of diabetic patients (n = 530) who underwent RYGB from January 2012 – December 2017, including those with a minimum of a 2-year post-operative follow up (n = 47). Preoperatively, BMI, HbA1c and the number of anti-diabetic medications and the duration of T2DM since diagnosis were recorded. These measurements were repeated at the end of the two year follow up. Results At the time of enrolment in the bariatric programme, the median BMI was 42.5 (range, 31.7-61.5) kg/m2, mean duration of T2DM was 58 months and median HbA1c was 59 (37-118) mmol/mol. The mean number of anti-diabetic medications taken, including insulin, was 2. At the end of 2-year follow-up, the median BMI was 32 (range, 24-41) kg/m2 and HbA1c was 41(range, 33-91) mmol/mol. 15 patients (31.9%) still required anti-diabetic medication, 12 of whom had a diagnosis of T2DM for 3 years or more at time of enrolment. Conclusions RYGB is strongly associated with a resolution of T2DM in morbidly obese patients. In those who were not resolved, the number of anti-diabetic medications taken and HbA1c were reduced. The impact of the surgery is dependent on the duration of T2DM since diagnosis preoperatively.

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