Surgical removal is recommended for gastrointestinal stromal tumours (GISTs) larger than 3 cm due to their potential for malignancy but limited wedge resection is not possible in the proximal stomach. Endoscopic removal of larger lesions has been technically limited in complex anatomical regions such as cardia. We report two cases of large proximal (cardia/fundus) GIST tumours (51 and 60 mm) which were downsized (to 26 and 36 mm) by 3–7 months of imatinib therapy followed by transmural endoscopic resection. Follow-up of 23 and 16 months including endoscopy and CT was unremarkable. GISTs commonly occur in the stomach.1 2 Due to their malignant potential, surgery is generally recommended.3–5 Recently, endoscopic resection of submucosal tumours (SMTs) has made significant progress.6 The European Society of Gastrointestinal Endoscopy recommended endoscopic resection for gastric GISTs<35 mm projecting into the lumen.3 Endoscopic full-thickness resection (EFTR), an extension of submucosal dissection, has shown promising results for SMTs arising from the deep muscularis propria (MP), particularly in the gastric fundus.7 However, achieving R0 resection in GISTs>35 mm remains challenging.8 Large GISTs in anatomically complex areas such as the cardia and fundus may still necessitate surgical resection.2 Radical surgery, however, poses risks to cardia function and patient quality of life.9 Preoperative imatinib can shrink tumours, reduce mitotic activity and lower recurrence risk.9 10 The American College of Gastroenterology guidelines suggested neoadjuvant imatinib to facilitate tumour reduction in large GISTs, enhancing the feasibility of minimally invasive endoscopic resection. Hence, in this context, we explored the combination of preoperative imatinib with EFTR as a novel, minimally invasive strategy for treating large gastric GISTs. Our primary outcomes suggested this approach may be a viable alternative for GISTs in gastric anatomical complex regions. Case 1 was a 65-year-old woman with abdominal distension and belching for several months. Gastroscopy revealed …

中文翻译：

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大近端胃 GIST 肿瘤：通过伊马替尼和随后的内切术缩小大小


对于大于 3 cm 的胃肠道间质瘤 （GIST），建议手术切除，因为它们可能成为恶性肿瘤，但不可能在近端胃进行有限的楔形切除术。在复杂的解剖区域（如贲门）中，内窥镜切除较大的病灶在技术上受到限制。我们报告了两例大的近端（贲门/眼底）GIST 肿瘤 （51 和 60 mm），在伊马替尼治疗 3-7 个月后进行透壁内窥镜切除术后缩小（至 26 和 36 mm）。23 个月和 16 个月的随访（包括内窥镜检查和 CT）无异常。GIST 通常发生在胃中。1 2 由于其恶性潜力，通常建议手术治疗。3-5 最近，粘膜下肿瘤 （SMT） 的内窥镜切除术取得了重大进展。6 欧洲胃肠内窥镜学会推荐对突出到管腔的胃 GIST<35 mm 进行内窥镜下切除。3 内窥镜全层切除术 （EFTR） 是粘膜下剥离术的延伸，已显示出对源自深部肌层的 SMT 的良好结果7 然而，在 GIST>35 mm 中实现 R0 切除仍然具有挑战性.8 在解剖学复杂区域（如贲门和眼底）中的大 GIST 可能仍需要手术切除.2 然而，根治性手术对贲门功能和患者生活质量构成风险.9 术前伊马替尼可以缩小肿瘤，减少有丝分裂活性并降低复发风险.9 10 美国胃肠病学会指南建议新辅助治疗伊马替尼促进大 GIST 的肿瘤复位，提高微创内窥镜切除术的可行性。 因此，在这种情况下，我们探索了术前伊马替尼与 EFTR 的结合作为治疗大胃 GIST 的新型微创策略。我们的主要结局表明，这种方法可能是胃解剖复杂区域 GIST 的可行替代方案。病例 1 是一名 65 岁的女性，患有腹胀和嗳气数月。胃镜检查显示......