Semash K, Dzhanbekov T. Redefining the treatment paradigm for esophageal gastrointestinal stromal tumors: The emerging role of endoscopic resection. World J Gastroenterol 2025; 31(24): 106440 [DOI: 10.3748/wjg.v31.i24.106440]
Corresponding Author of This Article
Konstantin Semash, MD, PhD, Department of Mini-Invasive Surgery, National Children's Medical Center, Parkent Street 294, Tashkent 100171, Uzbekistan. doctorsemash@gmail.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 28, 2025; 31(24): 106440 Published online Jun 28, 2025. doi: 10.3748/wjg.v31.i24.106440
Redefining the treatment paradigm for esophageal gastrointestinal stromal tumors: The emerging role of endoscopic resection
Konstantin Semash, Timur Dzhanbekov
Konstantin Semash, Timur Dzhanbekov, Department of Mini-Invasive Surgery, National Children's Medical Center, Tashkent 100171, Uzbekistan
Co-first authors: Konstantin Semash and Timur Dzhanbekov.
Author contributions: Semash K and Dzhanbekov T jointly conceived the topic, performed the literature review, structured and drafted the manuscript, prepared the figures and table, and approved the final version of the article.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantin Semash, MD, PhD, Department of Mini-Invasive Surgery, National Children's Medical Center, Parkent Street 294, Tashkent 100171, Uzbekistan. doctorsemash@gmail.com
Received: February 26, 2025 Revised: April 12, 2025 Accepted: June 5, 2025 Published online: June 28, 2025 Processing time: 120 Days and 11.3 Hours
Abstract
Esophageal gastrointestinal stromal tumors (GISTs) are exceedingly rare, often detected incidentally due to their asymptomatic nature. Historically, esophagectomy or enucleation has been the standard treatment, but these procedures carry significant morbidity. The retrospective study by Xu et al provides compelling evidence that endoscopic resection (ER) is a viable, minimally invasive alternative for low-risk esophageal GISTs, demonstrating a high en bloc resection rate (96.9%) and favorable long-term oncologic outcomes, including a 5-year overall survival rate of 100% and disease-free survival of 90.6%. These results challenge the conventional surgical paradigm and highlight the need for a paradigm shift towards endoscopic approaches in carefully selected patients. However, several critical questions remain unanswered: What are the precise selection criteria for ER candidacy? How does ER compare to traditional surgical methods in terms of recurrence risk and long-term functional outcomes? Could neoadjuvant therapy enhance the feasibility of ER for larger lesions? As endoscopic techniques continue to evolve, interdisciplinary collaboration among gastroenterologists, oncologists, and surgeons will be crucial to refining treatment algorithms and optimizing patient outcomes. Future prospective studies and randomized trials are warranted to solidify the role of ER as the standard of care for esophageal GISTs.
Core Tip: Endoscopic resection (ER) is emerging as a minimally invasive alternative to traditional surgery for esophageal gastrointestinal stromal tumors (GISTs), particularly for tumors ≤ 4 cm with low mitotic activity. The study by Xu et al provides compelling evidence supporting ER’s high en bloc resection rate and favorable long-term outcomes. However, critical questions remain regarding patient selection criteria, the oncologic safety of R1 resections, and the role of adjuvant therapy. Further prospective studies are needed to define ER’s place in the treatment algorithm and optimize management strategies for esophageal GISTs.
