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中华胃肠内镜电子杂志 ›› 2020, Vol. 07 ›› Issue (04) : 176 -185. doi: 10.3877/cma.j.issn.2095-7157.2020.04.002

所属专题: 文献 指南共识

共识与指南

中国胃肠间质瘤内镜下诊治专家共识意见(2020,北京)
中华医学会消化内镜学分会消化内镜隧道技术协作组1, 中国医师协会内镜医师分会2, 北京医学会消化内镜学分会3   
  1. 1. 100710 北京,中华医学会消化内镜学分会消化内镜隧道技术协作组
    2. 100055 北京,中国医师协会内镜医师分会
    3. 100031 北京,北京医学会消化内镜学分会
    4. 100853 北京,解放军总医院第一医学中心消化内科
    5. 200433 上海,海军军医大学长海医院消化内科
  • 收稿日期:2020-10-18 出版日期:2020-11-15

Consensus of Chinese experts on the endoscopic diagnosis and treatment of gastrointestinal stromal tumor (2020, Beijing)

Chinese Society of Digestive Endoscopy1, Chinese Digestive Endoscopy Association2, Beijing Digestive Endoscopy Society3   

  • Received:2020-10-18 Published:2020-11-15
引用本文:

中华医学会消化内镜学分会消化内镜隧道技术协作组, 中国医师协会内镜医师分会, 北京医学会消化内镜学分会. 中国胃肠间质瘤内镜下诊治专家共识意见(2020,北京)[J]. 中华胃肠内镜电子杂志, 2020, 07(04): 176-185.

Chinese Society of Digestive Endoscopy, Chinese Digestive Endoscopy Association, Beijing Digestive Endoscopy Society. Consensus of Chinese experts on the endoscopic diagnosis and treatment of gastrointestinal stromal tumor (2020, Beijing)[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2020, 07(04): 176-185.

表1 证据级别分类
表2 中国胃肠间质瘤内镜下诊治专家共识陈述汇总
推荐陈述
内镜治疗胃肠间质瘤的适应证与禁忌证
1.GIST治疗以手术±药物为主,内镜开始作为一部分GIST的常规治疗手段。
2.瘤体短时间内增大及患者内镜治疗意愿强烈的GIST可考虑行内镜下治疗。
3.直径介于2~5 cm之间的低风险GIST可考虑行内镜下治疗。
内镜治疗前检查及评估
4.GIST内镜治疗前均应行CT、白光内镜及EUS±FNA检查。
内镜治疗方法
5.内镜下治疗(ESD、EFR、STER及LECS)方式的选择应根据肿瘤的具体情况(肿瘤的发生部位、大小及是否向腔外生长等)及术者的临床经验等综合确定。
6.ESD主要适用于直径≥2 cm、并<5 cm,术前EUS或CT评估向腔内生长的GIST。
7.EFTR主要适用于术前EUS和CT评估起源于固有肌层,并向浆膜外生长及ESD术中发现瘤体与浆膜层紧密粘连而无法分离的GIST。
8.STER主要适用于食管(距咽部3~5 cm外)、贲门、胃大弯等易建立隧道部位的GIST。
术后标本的病理评估
9.GIST标本病理评估包括形态学、免疫组化及分子检测,CD117及DOG1常联合用于GIST的免疫组化诊断。
10.根据肿瘤大小、核分裂像计数、原发部位及术中完整性等建立原发GIST切除术后危险度分级。
治疗后的随访策略
11.应根据GIST术后危险度分级制定治疗后随访策略。
12.白光内镜或EUS辅以CT检查可作为随访的主要检查手段。
13.对于GIST内镜治疗后危险度分级为中高危的患者,可追加手术治疗。
图1 STER切除贲门GIST
表3 原发GIST切除术后危险度分级(NIH 2008改良版)
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