Endoscopic Procedure Removes GIST Without Surgery

A novel endoscopic technique called submucosal tunneling endoscopic resection (STER) allowed a UC Davis Health patient to have a gastrointestinal stromal tumor (GIST) removed without surgery, enabling faster recovery and fewer complications, according to a news release from UC Davis Health.

Jeffrey Lipow didn’t expect anything unusual from a routine endoscopy — until doctors found a hidden tumor beneath the stomach’s inner lining. An endoscopic ultrasound and biopsy confirmed it was a GIST.

The gastrointestinal tract is made up of four layers: the mucosa, submucosa, muscularis propria and adventitia, according to the release. Tumors in the first two layers may be removed during an endoscopy, however; GISTs form in the muscularis propria, making surgical removal the standard approach.

Within a day of surgery to remove the tumor from his stomach’s muscle layer, Lipow was home recovering.

“To be honest, I wasn’t thrilled with the idea of needing surgery,” Lipow stated in the news release. “So, the care team looked into the different treatment options available.”

Patients who are diagnosed with GIST tumors will get their complex case studied by a multidisciplinary team of gastroenterologists, pathologists and oncology surgeons, known as the tumor board. These boards meet regularly to discuss treatment options for the patients.

At first the care team attempted to shrink Lipow’s tumor with medication.

“Luckily, the medication worked, and the tumor did shrink,” Lipow recollected, “but not enough.”

The tumor board, after a long discussion, recommended that the tumor needs to be surgically removed. Lipow then met with the surgeon in which he expressed his interest in searching for other, less invasive options.

Lipow was then referred to UC Davis Health’s interventional endoscopy service, where Dr. Antonio Mendoza-Ladd, medical director of gastrointestinal endoscopy, reviewed his case. Mendoza-Ladd recommended removing the tumor with a new endoscopic technique called STER. In addition, UC Davis Health is the only facility in the Sacramento area that performs the procedure.

“I thought this was a much better alternative; they didn’t have to cut into me!” he said.

Fewer than 24 hours after undergoing the STER procedure, Lipow returned home to Placerville.

“I was on a liquid diet for a few days, but other than that I was back to my normal activities, like walking my dog, pretty quickly,” Lipow said.

He credited the interventional endoscopy team for considering his preferences and contributing to his smooth recovery.

“I appreciated the options they provided, allowing me to avoid surgery and be back to my normal routine so quickly,” he said.

Diving Deeper into the STER Procedure and Current Standard of Care

During a STER procedure, doctors make a small cut in the innermost layer of tissue a few centimeters from the tumor to create a tunnel between layers, according to the news release. This approach avoids cutting through the stomach. The tumor is then removed through the tunnel, which is sealed to complete the procedure.

“With this novel procedure, we were able to easily remove the tumor without any incisions in the skin, which speeds up the recovery time of patients and avoids potential post-surgical complications,” Dr. Antonio Homero Mendoza Ladd stated in the news release.

Mendoza-Ladd is the medical director of endoscopy and an associate professor in the division of gastroenterology, department of internal medicine at UC Davis Health.

According to the National Library of Medicine, the standard treatment for localized gastrointestinal stromal tumors (GISTs) is complete surgical resection. Patients with a high risk of GIST coming back may receive Gleevec (imatinib) after surgery, especially if specific gene mutations are present. Genetic testing is needed first. Gleevec may also be used before surgery in certain cases to help shrink the tumor.

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