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The endoscopist will perform endoscopic resection for patients enrolled in this group.

The endoscopist will perform laparoscopic partial gastrectomy for patients enrolled in this group.

Endoscopic submucosal dissection (ESD) or endoscopic full-thickness resection (EFTR) for patients with 2-5cm gastric GISTs

Endoscopic resection

Laparoscopic partial gastrectomy for patients with 2-5cm gastric GISTs

Laparoscopic partial gastrectomy

Tianyin Chen

Pinghong Zhou

This research is a prospective, multi-center trial for endoscopic resection and laparoscopic partial gastrectomy in patients with 2-5cm gastric gastrointestinal stromal tumor. The primary purpose of this study is to evaluate the early operative morbidity and mortality and determine the safety of endoscopic resection compared with laparoscopic partial gastrectomy for 2-5cm gastric gastrointestinal stromal tumor. The second purpose is to evaluate the recovery course and compare the postoperative hospital stay of the patients enrolled in this study.

Gastrointestinal stromal tumors (GIST) originate from interstitial cells of Cajal (ICC) and are the most common tumors derived from mesenchymal tissues of the digestive tract. GISTs can occur in any part of the digestive tract, among which gastric stromal tumors are the most common, accounting for about 60%. The incidence of GIST has been increasing in recent years, partly due to the gradual popularity of gastrointestinal endoscopy. Many early GISTs with smaller tumors have also received early diagnosis and treatment intervention. Due to the potential malignancy of GISTs, complete resection of the tumor is the first and only radical treatment option currently.

Many studies have shown that laparoscopy is safe and effective approach in the treatment of gastric stromal tumors. In principle, as long as the tumor can be completely resected (neither residue macro nor microscopic) with intact tumor capsule and without tumor rupture, laparoscopic surgery is definite an option. Studies showed both short-term and long-term results of laparoscopic surgery were comparable to conventional open surgeries.

On the other hand, endoscopic resection showed promising results in recent years. Endoscopic submucosal dissection endoscopic full-thickness resection are both reported with promising results in terms of safety and short-term efficacy.

Though endoscopic resection has been suggested as one of the treatment options for gastric GISTs, No randomized controlled trial for endoscopic resection versus laparoscopic partial gastrectomy exists at this moment. This research is a prospective, multi-center trial for endoscopic resection and laparoscopic partial gastrectomy in patients with 2-5cm gastric GISTs. The primary purpose of this study is to evaluate the early operative morbidity and mortality and determine the safety of endoscopic resection compared with laparoscopic partial gastrectomy for 2-5cm gastric GISTs. The second purpose is to evaluate the recovery course and compare the postoperative hospital stay of the patients enrolled in this study.

Study On Safety Of Endoscopic Resection For 2-5cm Gastric Gastrointestinal Stromal Tumor

Prospective Randomized Controlled Multicenter Clinical Trial For Comparison Of Safety Between Endoscopic Resection And Laparoscopic Partial Gastrectomy In Patients With 2-5cm Gastric Gastrointestinal Stromal Tumor

The early operative morbidity is defined as the event observed within 30 days following surgery, including intraoperative and postoperative complications.

The early operative mortality is defined as deaths observed within 30 days following surgery.

Operation time is documented as a composite outcome measure.

Time to first ambulation is used to assess the postoperative recovery course, which is a composite outcome measure.

Time to first flatus is used to assess the postoperative recovery course, which is a composite outcome measure.

Time to first liquid diet is used to assess the postoperative recovery course, which is a composite outcome measure.

Time to first soft diet is used to assess the postoperative recovery course, which is a composite outcome measure.

The length of postoperative hospital stay will be recorded.

The rate of en bloc resection in all cases will be recorded.

Shanghai Zhongshan Hospital

With institutional review board approval from Zagazig University Hospitals 338. A double-centre prospective study was conducted on prospectively collected data of all morbidly. 17 patients in Zagazig University Hospitals, Faculty of Medicine, Egypt and 321 patients done in bariatric surgery excellence unit in a tertiary hospital in Riyadh-KSA.

Excision of Gastric GIST along fundus or body of stomach in the same specimen of LSG with safety margin 1-2cm

Laparoscopic sleeve gastrectomy

Bassem M Sieda

LSG is thought to be the best choice for obese patients with conincidental GISTs, as a tumour can be resected along with resecting the stomach within the same procedure. The primary endpoint is that, how much does GIST suppose to be far from a staple line to do safe laparoscopic sleeve gastrectomy

The incidence of unsuspected GIST in LSG specimens in our series was high in comparison to cases reported in the literature.

GISTs could be safely removed laparoscopically during LSG surgery with negative microscopic resection margins, with 1-2cm safety margin. Margins less than 1cm, high mitotic rate are adverse prognostic factors.

Examining the whole stomach before resection is mandatory and can easily be done during LSG, GIST can be removed safely with LSG

Incidental Finding of Gastrointestinal Stromal Tumors (GISTs) During Laparoscopic Sleeve Gastrectomy, How to Deal? How Much Safety Margin

WHEN REGISTERED AND APPROVED FOR PUBLICATION, I WILL SHARE THROUGH ALL SCIENTIFIC SITES

we analyzed the incidence of GISTs in patients underwent LSG and investigated whether simultaneous resection can be oncologically adequate. as long as GIST is distal to staple line with a negative margin, laparoscopic sleeve gastrectomy can be done safely.

Bassem Mohamed Sieda

Assistant professor of general surgery, faculty of medicine

Resection of the gastric GIST by ESD techniques followed by endoscopic closure of defect with suturing or clips and loop

Endoscopic full thickness resection achieved by resecting the submucosal tumor using retraction techniques and submucosal dissection, followed by closure

Endoscopic Full Thickness Resection

Philip Wai Yan Y Chiu, MD, FRCSEd

Man Yee Yung

Philip WY Chiu, MD

Philip Wai Yan Chiu, MD, FRCSEd

This is a clinical trial to evaluate the efficacy and safety of endoscopic full thickness resection for treatment of gastric GIST

To evaluate the clinical safety and efficacy of endoscopic full thickness resection (EFTR) for treatment of gastric GIST. A total of 30 patients will be recruited

Endoscopic Full Thickness Resection for Gastric GIST

Prospective Clinical Study on Safety and Effectiveness of Endoscopic Full Thickness Resection for Treatment of Patients With Gastric Gastrointestinal Stromal Tumors (GIST)

Complete resection of the GIST defined by en-bloc resection in one piece by endoscopy with clear resection margins

Adverse event as defined by presence of either postoperative bleeding or leakage after closure

Histology outcome as defined by any involvement of the tumor margins after resection

Technical success defined by complete endoscopic resection, closure of the defect and delivery of the specimen per orally without need of conversion to laparoscopic surgery

Chinese University of Hong Kong

Professor

Stomach Neoplasms

Stomach Diseases

Stomach Cancer

patients with suspected gastric GIST with size \> 2cm are subjected for laparoscopic resection.

all patients with suspected Gastric GIST undergoes laparoscopic resection. Tumour location decides the approach used for resection. Therefore, a variety of options such as local resections, wedge resections, transgastric resections, intragastric resection and partial gastrectomies were performed.

Laparoscopic resection

sandeep sabnis, DNB SGE

Gastric GISTs are rare neoplasms that require excision for cure. Although the feasibility of laparoscopic resection of gastric GIST less than 2cms has been established, the feasibility, safety and long-term efficacy of these techniques for larger lesions are unclear. Investigators hypothesized that laparoscopic resection of gastric GISTs even for larger lesions is feasible \& results in low perioperative morbidity and an effective long-term control of the disease.

Open surgical resection was the standard of treatment until two decades ago, but with advent laparoscopy and experienced gained over the years, the safety \& feasibility of laparoscopic resections of gastric GISTs has been proven but for tumors less than 2 cm. However, with gain of experience and skill in laparoscopic surgery, many surgeons have reported a safety \& feasibility excision of tumors greater than 5 cm. Our current study demonstrates the oncologic safety of the laparoscopic approach even with tumour size range up to 12cm, with efficacy and recurrence rates similar or superior to historical open surgical controls, however, it requires considerable expertise for safe manipulation of the tumour. All these resections were accomplished with minimal morbidity, no perioperative mortality, and short post-operative stay and comparable long term oncological outcomes.

Laparoscopic Management of Gastrointestinal Stromal Tumor of Stomach

Gastrointestinal Stromal Tumor of Stomach: Feasibility of Laparoscopic Resection in Large Lesions and Its Long Term Outcomes- A Case Series

Any instances of tumour rupture during surgery is noted.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Study On Safety Of Endoscopic Resection For 2-5cm Gastric Gastrointestinal Stromal Tumor	NCT04751591	Gastric GIST	Endoscopic rese... Laparoscopic pa...	18 Years - 80 Years	Shanghai Zhongshan Hospital
Incidental Finding of Gastrointestinal Stromal Tumors (GISTs) During Laparoscopic Sleeve Gastrectomy, How to Deal? How Much Safety Margin	NCT04344847	Excision Margin	Laparoscopic sl...	21 Years - 42 Years	Zagazig University
Endoscopic Full Thickness Resection for Gastric GIST	NCT04198337	Gastric GIST	Endoscopic Full...	18 Years - 80 Years	Chinese University of Hong Kong
Laparoscopic Management of Gastrointestinal Stromal Tumor of Stomach	NCT03722056	Gastric GIST Submucosal Tumo...	Laparoscopic re...	18 Years -	GEM Hospital & Research Center
Study On Safety Of Endoscopic Resection For 2-5cm Gastric Gastrointestinal Stromal Tumor	NCT04751591	Gastric GIST	Endoscopic rese... Laparoscopic pa...	18 Years - 80 Years	Shanghai Zhongshan Hospital
Endoscopic Full Thickness Resection for Gastric GIST	NCT04198337	Gastric GIST	Endoscopic Full...	18 Years - 80 Years	Chinese University of Hong Kong

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