# Endoscopic Resection of an Esophageal Gastrointestinal Stromal Tumor After Neoadjuvant Treatment: A New Paradigm for Minimally Invasive Therapy?

## TL;DR

A patient with a large esophageal tumor was successfully treated with a new approach combining drug therapy and minimally invasive surgery.

## Contribution

This case suggests that shrinking tumors with drugs before endoscopic removal may expand treatment options for rare esophageal tumors.

## Key findings

- Neoadjuvant imatinib therapy reduced the tumor size, enabling endoscopic resection.
- The patient remained in remission one year after the procedure.
- This approach may increase the feasibility of minimally invasive therapy for larger eGISTs.

## Abstract

Esophageal gastrointestinal stromal tumors (eGISTs) are rare. Current guidelines recommend surgical R0 resection. Here, we report on a patient diagnosed with a larger (>30 mm) localized GIST in the midesophagus. After interdisciplinary discussion and discussion with the patient, we initiated a neoadjuvant therapy with imatinib 400 mg. The tumor was downsized and removed uneventfully by endoscopic tunneling resection. Histopathology showed a 19 × 18 × 17 mm ypT1-R1 eGIST. After shared decision-making, the patient continues therapy with imatinib and is in remission 1 year after resection. Downsizing by neoadjuvant treatment could increase the number of endoscopically resectable eGISTs.