Redefining the treatment paradigm for esophageal gastrointestinal stromal tumors: The emerging role of endoscopic resection

Esophageal gastrointestinal stromal tumors (GISTs) are exceedingly rare, often detected incidentally due to their asymptomatic nature. Historically, esophagectomy or enucleation has been the standard treatment, but these procedures carry significant morbidity. The retrospective study by Xu et al provides compelling evidence that endoscopic resection (ER) is a viable, minimally invasive alternative for low-risk esophageal GISTs, demonstrating a high en bloc resection rate (96.9%) and favorable long-term oncologic outcomes, including a 5-year overall survival rate of 100% and disease-free survival of 90.6%. These results challenge the conventional surgical paradigm and highlight the need for a paradigm shift towards endoscopic approaches in carefully selected patients. However, several critical questions remain unanswered: What are the precise selection criteria for ER candidacy? How does ER compare to traditional surgical methods in terms of recurrence risk and long-term functional outcomes? Could neoadjuvant therapy enhance the feasibility of ER for larger lesions? As endoscopic techniques continue to evolve, interdisciplinary collaboration among gastroenterologists, oncologists, and surgeons will be crucial to refining treatment algorithms and optimizing patient outcomes. Future prospective studies and randomized trials are warranted to solidify the role of ER as the standard of care for esophageal GISTs.

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