Endoscopic resection for small rectal gastrointestinal stromal tumors: a pilot study

Rectal gastrointestinal stromal tumors are a rare subset of gastrointestinal stromal tumors with malignant potential, making their management clinically challenging. This study sought to assess the feasibility, safety, and efficacy of endoscopic resection as a primary treatment for these tumors. This study conducted a retrospective analysis and follow-up of clinical data from 18 patients who were diagnosed with rectal gastrointestinal stromal tumors (GISTs) and who underwent endoscopic resection at Zhongshan Hospital, affiliated with Fudan University, from February 2018 to May 2025. This study aimed to outline the clinicopathological characteristics, endoscopic diagnostic approaches, and therapeutic insights specific to rectal GIST patients. A series of 18 rectal GIST patients underwent endoscopic resection with 100% success in achieving en bloc and R0 resection. The cohort had a 1:1 gender ratio and a mean age of 56. Most (77.8%) were asymptomatic. All the tumors were solitary, peri-anal lesions (4–35 mm). The procedures were efficient (median: 37.5 min) and safe, with no intraoperative complications. Three minor postoperative issues arose but were self-limiting. The median hospitalization duration was 3 days, and notably, no recurrence was found after a median 29-month follow-up. Although based on a small cohort, endoscopic resection proved feasible and safe for small rectal GISTs (≤ 3 cm), achieving high complete resection and no recurrence. This provides preliminary support for its use, pending confirmation in larger comparative trials.