Is a “wait-and-see” policy the best for small gastric gastrointestinal stromal tumor (GIST)?

Several months ago, a middle-aged female patient presenting with a gastrointestinal stromal tumor (GIST) visited me at Sanjo General Hospital to seek a second opinion of her disease. The patient was asymptomatic and a diagnosis of submucosal tumor (SMT) in the stomach was made on the basis of barium swallow in a health examination. The incidentally found SMT was located at the gastric fornix and not associated with ulceration. Endoscopic ultrasonography (EUS) and computed tomography (CT) both showed that the tumor had a homogenous content and measured approximately 1.8 cm in maximal diameter. EUS-guided fine-needle aspiration (FNA) disclosed KIT-positive spindle cells. A diagnosis of GIST was made, and the attending physician recommended that she undergo surgical resection of the tumor. The query of the patient was whether surgery was mandatory or not although she preferred not to. I informed her of the potentially malignant nature of GIST and the very low risk of metastasis in her case and advised that resection was essentially recommended although she could take a wait-and-see strategy with regular follow-up. The patient finally chose watchful waiting and was scheduled for another CT 6 months later.