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World J Gastrointest Endosc. Jul 16, 2014; 6(7): 266-271
Published online Jul 16, 2014. doi: 10.4253/wjge.v6.i7.266
Management of early asymptomatic gastrointestinal stromal tumors of the stomach
Hans Scherübl, Siegbert Faiss, Wolfram-Trudo Knoefel, Eva Wardelmann
Hans Scherübl, Klinik für Innere Medizin II, Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany
Siegbert Faiss, III. Med. Abteilung, Asklepios Klinik Barmbek, 22291 Hamburg, Germany
Wolfram-Trudo Knoefel, Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum, 40225 Düsseldorf, Germany
Eva Wardelmann, Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, 48149 Münster, Germany
Author contributions: All the authors contributed to this paper.
Correspondence to: Dr. Hans Scherübl, Professor, Klinik für Innere Medizin II, Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, Dieffenbachstrasse 1, 10967 Berlin, Germany. hans.scheruebl@vivantes.de
Telephone: +49-30-130225201 Fax: +49-30-130225205
Received: February 23, 2014
Revised: April 24, 2014
Accepted: June 10, 2014
Published online: July 16, 2014

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. Approximately two thirds of clinically manifest tumors occur in the stomach, nearly one third in the small bowel, and the rest in the colorectal region with a few cases in the esophagus. GIST originate within the smooth muscle layer in the wall of the tubular gastrointestinal tract and grow mostly toward the serosa, far less often toward the mucosa. In the latter case, ulceration may develop and can cause gastrointestinal bleeding as the cardinal symptom. However, most GIST of the stomach are asymptomatic. They are increasingly detected incidentally as small intramural or submucosal tumors during endoscopy and particularly during endoscopic ultrasound. Epidemiological and molecular genetic findings suggest that early asymptomatic GIST of the stomach (< 1 cm) show self-limiting tumorigenesis. Thus, early (< 1 cm) asymptomatic gastric GIST (synonym: micro-GIST) are found in 20%-30% of the elderly. The mostly elderly people with early gastric GIST have an excellent GIST-specific prognosis. Patients with early GIST of the stomach can therefore be managed by endoscopic surveillance.

Keywords: Mirco-gastrointestinal stromal tumors, Gastrointestinal stromal tumor, Gastric, Neoplasia, Cancer, Endoscopy, Endoscopic ultrasound

Core tip: Small gastric gastrointestinal stromal tumors (GIST) are by far the commonest neoplasias of the stomach. Thus, early gastric GIST of less than 1 cm in size are found in 20%-30% of the elderly. The natural disease-specific prognosis of early gastric GIST (< 1 cm), also called micro-GIST, is excellent in the mostly elderly patients. Micro-GIST of the stomach appear to have a self-limiting tumorigenesis. Local endoscopic or surgical resection of early asymptomatic GIST (< 1 cm) of the stomach is in general not indicated in the elderly. Instead endoscopic surveillance is advised.