Flexible Endoscopic Vs. Laparoscopic Resection for Gastrointestinal Stromal Tumors of Esophagogastric Junction (EGJ-GIST): A Propensity Score-Matched Case-Control Study

Aims To compare the safety and efficacy of endoscopic resection (ER) versus laparoscopic resection (LR) for gastrointestinal stromal tumors (GISTs) located at the esophagogastric junction (EGJ-GIST).

Methods We adopted propensity score matching (1:1) to compare ER and LR for patients with EGJ-GIST between December 2013 and November 2023 at the First Affiliated Hospital of Zhengzhou University, China. We reviewed 176 patients (ER 82; LR 94) with EGJ-GIST, of whom 85 patients with a tumor size of 2-5cm met the matching criteria (ER 42; LR 43), yielding 20 pairs of patients.

Results The postoperative nil per os (NPO) time was 5.5 days (IQRs, 4.3-7.8) in the LR group, which was significantly higher than that in the ER group (4.0 days (IQRs, 3.0-5.0) (p=0.005). Median hospital length of stay were significantly lower in the ER group (6.0 days (IQRs, 5.0-6.8)) than LR group (8.5 days (IQRs, 6.0-11.8) (p=0.002). The overall long-term adverse event rate was 55% in the LR group and 15% in the ER group, with a significant difference between the two groups (p=0.005). Neither group experienced recurrence or distant metastasis during the median 46.4 months of follow up time.

Conclusions Endoscopic resection was a promising alternative therapeutic modality for EGJ-GISTs measuring 2 to 5 cm. Its advantages includes reduced trauma, potential preservation of the anatomical integrity of the EGJ, shorter hospital stay, fewer adverse events, and notable enhancement of long-term quality of life for patients.

Publication History

Article published online:
27 March 2025