[A retrospective study of 22 years endoscopic follow-up in elderly patients with gastrointestinal submucosal tumors].

Objective: To observe the occurrence characteristics, dynamic variations and potential risks of smaller gastrointestinal submucosal tumor (SMT) in elderly patients.

Methods: A total of 54 SMT patients were retrospectively recruited from January 1981 to September 2010. There were 51 males (94.4%) and 3 females (5.6%) with an average age of (74 ± 1) years. During each visit, all the relevant data were collected, including symptoms, number of lesion, lesion location, shape, size (maximum transverse diameter under endoscope or endoscopic ultrasonography (EUS), morphology of mucosa, frequency and duration of follow-ups, treatment and pathological results. And the data were analyzed to examine the characteristics of SMT in elderly patients and their dynamic variations. Further more, according to lesion diameter, they were divided into two groups: a diameter ≤ 1 cm (n = 36) and a diameter > 1 cm and ≤ 3 cm (n = 16). Then the change of two groups were observed and compared during the follow-ups.

Results: Two cases were not under surveillance after direct surgical resection. The other 52 patients received a follow-up of 22 years. Among them, 5 patients underwent surgical resection for fast-growing tumor and mucosal ulcer. And all their pathologic diagnoses were malignant. Only 1 patient (2.8%) in the diameter ≤ 1 cm group and 4 in the diameter > 1 cm and ≤ 3 cm group turned malignant at 6 years. But, among 4 patients, the shortest interval was merely 14 months. Therefore, compared with the diameter > 1 cm group, the diameter ≤ 1 cm group had a lower rate of malignancy (P < 0.05).

Conclusions: The incidence of smaller SMT (especially diameter ≤ 1 cm) is high in elderly patients, but the malignant potential remains low. Therefore, for elderly patients whose diameters of SMT are no bigger than 3 cm and without obvious malignancy under endoscope or EUS, we may plan an appropriate surveillance interval based on the size of tumor during a long follow-up period.