True Incidence of Gastrointestinal Stromal Tumors; Is It Hight Than We Anticipated?

Shoshana Hacker, MD, Hernan Urrego, MD, Karleena Tuggle. Atlanta Medical Center

Introduction: Gastrointestinal tumors are rare tumors of the gastrointestinal tract. These tumors are found within the submucosal layers of the bowel therefore making their diagnosis difficult on Esophagogastroduodenoscopy.  Gastrointestinal stromal tumors are most commonly found in the stomach. There incidence is 1 per 100,000 in the general population.  Morbidly obese patients undergoing sleeve gastrectomy provide access to additional pathology from the excised stomach specimen taken in their procedure that could not otherwise be evaluated in asymptomatic patients.

Hypothesis:  The incidence of gastrointestinal stromal tumor in the general population may be higher than originally described. A number of patients with asymptomatic gastrointestinal stromal tumors can be identified on gastric sleeve pathology.

Methods: A retrospective analysis of 275 patients who underwent laparoscopic sleeve gastrectomy between the dates August 2014 to August 2015 at a bariatric center of excellence was conducted.  Pathology of all specimens was reviewed.  Patient demographics were collected such as age, gender, co-morbidities and tobacco history. The prevalence of gastrointestinal stromal tumors in the gastric sleeve population was compared to the prevalence of gastrointestinal stromal tumors in the general population.

Results:  Pathologic findings were evaluated in the patients that underwent laparoscopic gastric sleeve procedure between of the dates of August 2014 to August 2015. 275 reports were reviewed.  Three patients were found to have gastrointestinal stromal tumors in the resected gastric specimen. The incidence of gastrointestinal stromal tumors in the laparoscopic gastric sleeve population was 1.1 %.  The size of the gastrointestinal stromal tumors ranged between 0.5-1 cm. Patients that were found to have gastrointestinal stromal tumors had a common finding of size less than 0.5cm and  low mitotic rate. None of the patient required further treatment for their tumors.  

Conclusion:  The incidence of asymptomatic gastrointestinal tumors seen in gastric sleeve patients was higher than those estimated in the general population, 1.1% vs. 0.001% respectively which was statistically significant. (T score 1.815, P value of 0.03509.) There may be a correlation between gastrointestinal tumors in obesity that reveals a higher incidence in this selection of patients.

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