阿部圭一朗先生の論文が、Digestion (Journal Citation Reports Impact Factor 2021 = 3.672)にpublishされました。本研究にご協力いただいた栃木県内24施設の関係医療機関-NUTSHELL20 Study group-の皆様に心より御礼申し上げます。

Digestion. 2022 Dec 5;1-13. doi: 10.1159/000527421. Online ahead of print.

Natural History of Small Gastric Subepithelial Lesions Less than 20 mm: A Multicenter Retrospective Observational Study (NUTSHELL20 Study)

Keiichiro Abe, Keiichi Tominaga, Akira Yamamiya, Yasunori Inaba, Akira Kanamori, Masayuki Kondo, Tsunehiro Suzuki, Hidetaka Watanabe, Masaki Kawano, Takashi Sato, Naoto Yoshitake, Tsuneo Ohwada, Maki Konno, Kazunobu Hanatsuka, Hironori Masuyama, Kenichi Goda, Yasuo Haruyama, Atsushi Irisawa, NUTSHELL20 Study group

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PMID: 36470211 DOI: 10.1159/000527421

Abstract
Background and aim: Small gastric subepithelial lesions (SELs) are sometimes encountered in daily esophagogastroduodenoscopy (EGD) practice, but whether once-annual or twice-annual endoscopy can provide sufficient follow-up remains unclear. Because follow-up based on small-SEL characteristics is important, this study clarified the natural history of gastric SELs less than 20 mm.

Methods: This retrospective multicenter observation study conducted at 24 Japanese hospitals during April 2000 to March 2020 examined small gastric SELs of ≤20 mm diameter. The primary outcome was the rate of size increase of those SELs detected using EGD, with growth times assessed irrespective of SEL pathological diagnoses.

Results: We examined 824 cases with tumors of 1-5 mm diameter in 298 (36.2%) cases, 6-10 mm in 344 (41.7%) cases, 11-15 mm in 112 (13.6%) cases, and 16-20 mm in 70 (8.50%) cases. An increase of small gastric SELs was observed in 70/824 patients (8.5%). The SELs larger than 6 mm increased, even after 10 years. No-change and increasing groups had no significantly different malignant findings at diagnosis. In cases of gastrointestinal stromal tumors (GISTs), internal cystic change in endoscopic ultrasound (EUS) is a risk factor for an increased tumor size. The predictive tumor growth cutoff size at initial diagnosis was 13.5 mm.

Conclusions: Small gastric SELs less than 20 mm have an approximately 8.5% chance of increase. Predictive markers for GIST growth are tumor size ≥13.5 mm and internal cystic change in EUS.

Keywords: Esophagogastroduodenoscopy; Gastric subepithelial lesion; Natural history; Tumor growth rate.

https://pubmed.ncbi.nlm.nih.gov/36470211/