Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.462
Peer-review started: February 11, 2021
First decision: March 29, 2021
Revised: April 4, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 15, 2021
Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract, but gastric stromal tumors (GSTs) are the most common. All GSTs have the potential to become malignant, and these can be divided into four different grades by risk from low to high: Very low risk, low risk, medium risk, and high risk. Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter. However, it is not clear whether small GSTs (sGSTs, i.e., those smaller than 2 cm in diameter) should be treated as early as possible. The National Comprehensive Cancer Network recommends that endoscopic ultrasonography-guided (EUS-guided) fine-needle aspiration biopsy and imaging (computed tomography or magnetic-resonance imaging) be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment. When EUS indicates a higher risk of tumor, surgical resection is recommended. There are some questions on whether sGSTs also require early treatment. Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective. We here address whether endoscopic therapy is also suitable for sGSTs. In this paper, we try to explain three questions: (1) Does sGST require treatment? (2) Is digestive endoscopy a safe and effective means of treating sGST? and (3) When sGSTs are at different sites and depths, which endoscopic treatment method is more suitable?
Core Tip: Gastric stromal tumors (GSTs) are all malignant, but generally, the smaller the diameter, the more likely the tumor is inert. However, GSTs smaller than 2 cm in diameter are also at risk of growing and becoming more malignant. Endoscopic treatment of GSTs smaller than 5 cm in diameter is comparable to surgical treatment. Early endoscopic resection is safe and effective when there are high risk factors for GSTs smaller than 2 cm in diameter or the patients cannot be followed regularly, and different endoscopic treatment methods can be selected according to the tumor site and depth.