Endoscopic Evaluation and Management of Gastric Stromal Tumors

Recent Findings Although these can be visualized on CT scan, endoscopic ultrasound (EUS) represents the standard method of evaluation and characterization using fine needle aspiration cytology (FNA) when indicated. While EUS-FNA can yield diagnostic cells, full characterization requires a sufficient volume of viable cells to do molecular analysis for c-KIT and determine the mitotic index. A new generation of fine needle biopsy (FNB) needles holds promise for improving our ability to fully characterize these lesions which will hopefully lead to improved management. Very small GISTs (< 1 cm) can probably be ignored, those between 1 and 2 cm are often surveyed, and those > 2 cm should be resected if the patient is fit and the lesion is in an accessible location. Though laparoscopic wedge resection is considered the standard of care, for small GISTs, those that are endophytic and/or located in a difficult position, pure endoscopic or hybrid laparoscopic-endoscopic approaches offer promise.