The feasibility of endoscopic resection for esophageal gastrointestinal stromal tumor.

Objectives: Esophageal gastrointestinal stromal tumor (e-GIST) is a rare type that is distinct from gastric GIST (g-GIST), and comprehensive studies are limited. The present study aims to compare the clinicopathological characteristics between e-GIST and g-GIST, evaluate the feasibility of using endoscopic resection (ER) to treat e-GIST, and explore its clinical implications.

Methods: Patients with GISTs from January 2010 to May 2019 were enrolled in this study. Comprehensive clinicopathological, endoscopic, and follow-up data were collected and systematically analyzed.

Results: There were 46 e-GIST patients and 366 g-GIST patients were enrolled. The distinct characteristics of e-GIST were as follows: (1) greater prevalence in male patients than in female patients, in contrast with the predominance of females among patients with g-GIST; (2) the median onset age was 61 years (range 20 to 80 years), with 58.7% of patients aged > 65 years in e-GIST; (3) the proportion of larger tumors was much more frequent in the esophagus; (4) greater incidence of ulceration/bleeding than in g-GIST; (5) increased mitotic count (≥ 5/50HPF). These factors collectively contribute to significantly shorter overall survival in e-GIST patients. Importantly, our analysis revealed that the outcomes of endoscopic resection (ER) were comparable to those of surgical resection for selected e-GISTs (tumor diameter ≤ 5 cm, without ulceration/bleeding, and mitotic count < 5/50HPF), with no significant differences in recurrence rate or survival time between these procedures.

Conclusions: This study highlights the distinct clinicopathological features of e-GIST from those of g-GIST with increased tumor size, ulceration/bleeding, and higher mitotic counts identified as significant prognostic factors. Our findings suggest that ER is a feasible and effective treatment approach for carefully selected e-GIST cases (tumor diameter ≤ 5 cm, without ulceration/bleeding), as assessed by endoscopic ultrasound (EUS). These results provide valuable insights for the management of this rare tumor subtype.