Upper GI 12

Aims: Gastrointestinal stromal tumours (GIST) represent a rare group of heterogenous mesenchymal tumours. The aim of this study was to analyse the clinical presentation and outcome for patients with oesophago-gastric stromal tumours managed in a single institution. Methods: Of 1312 patients undergoing assessment for oesophago-gastric tumours from 1994 to 2001, 25 (2 per cent) patients (median age 60 years, M:F ratio 1:1.1) had stromal tumours. The clinical features, management and long-term outcome was evaluated for these patients. Results: A total of 19 (76 per cent) gastric and 6 (24 per cent) oesophageal stromal tumours were seen during this period. The commonest symptoms were acute (n = 2) or chronic (n = 10) gastrointestinal haemorrhage (48 per cent), indigestion (20 per cent) and anorexia (32 per cent). Twenty underwent surgical resection (15 gastrectomy, 5 subtotal oesophagectomy). There were no in-hospital deaths. Three patients were unfit for surgery and one patient had an unresectable tumour at laparotomy. Tumours were classified as leiomyoma (80 per cent) and leiomyosarcoma (20 per cent) according to cellular atypia and mitotic rate. Leiomyosarcomas (mean diameter = 8 cm) were larger than leiomyomas (mean diameter = 4.1 cm, P = 0.03). 10 (45.5 per cent) tumours were epithelioid in origin including all sarcomas and 12 (54.5 per cent) were spindle cell. At a median follow up of 32 months all patients with a benign diagnosis were alive with no recurrent disease. Three of four sarcomas died of local recurrence at 6, 52 and 66 months. Conclusion: GISTs of the upper gastrointestinal tract are rare and most commonly present with gastrointestinal haemorrhage. Surgical resection has excellent outcome but tumour size and epithelioid cell origin are associated with an increased risk of malignancy.