Abstract
Introduction
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms (85%) of the gastrointestinal (GI) tract; duodenal GISTs constitute 3–5% of all GISTs and represent 10–30% of all malignant tumours of the duodenum. Rarely, patients present severe bowel obstruction, perforation or severe bleeding. The radical resection with complete removal of the tumour remains the main therapeutic approach. We performed a local resection in patients with suspected GIST admitted for emergency treatment for GI bleeding.
Cases
We present three cases of patients admitted for GI bleeding. The cause could be a GIST bleeding. In all cases, local resection was performed without a pancreaticoduodenectomy. Histological examination on surgical preparations showed that in two cases it was a GIST and in one case, it was a leiomyoma.
Discussion
Surgery remains the treatment of choice in the case of a GIST primitive without evidence of metastases, even for patients who are hospitalized for a bleeding emergency. Wide resections are not needed; it is important to remove completely the disease. In the case of duodenal GIST, it is important to get negative margins near the head of the pancreas, and this could take a PD. According to our experience and to the literature review, we believe that if the duodenal papilla or the periampullary region is not interested, you must perform a local resection. This is also because non-malignant tumours may present as GISTs and in these cases it is not recommended to run a PD.
Conclusion
The treatment of choice for duodenal GISTs is complete surgical resection with negative resection margins. When the papilla or the periampullary region is involved we choose to perform pancreaticoduodenectomy; otherwise it is better to perform a local resection. In fact, local resection has lower morbidity and mortality, with a comparable outcome.
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Abbreviations
- GISTs:
-
Gastrointestinal stromal tumours
- GI:
-
Gastrointestinal
- PD:
-
Pancreaticoduodenectomy
- CT:
-
Computed tomography
- NIH:
-
National Institutes of Health
- LR:
-
Local resection
- EUS:
-
Endoscopic ultrasound
- MRI:
-
Magnetic resonance imaging
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Informed consent to the radiological and surgical procedure and to the processing of own personal data was obtained from each individual study participant. In accordance with Italian Drug Agency (AIFA) guidelines, observational studies using retrospective data or materials do not require formal approval by the local ethics committee.
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Boselli, C., Cirocchi, R., Gemini, A. et al. Urgency surgical treatment for duodenal GISTs: analysis of aged patients and review of the literature. Aging Clin Exp Res 29 (Suppl 1), 1–6 (2017). https://doi.org/10.1007/s40520-016-0641-3
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DOI: https://doi.org/10.1007/s40520-016-0641-3