Background: Gastroesophageal junction GISTs (GEJG) are currently classified under gastric GISTs. Laparoscopic resection of GEJG pose certain unique challenges owing to their location. Management guidelines for GEJG are currently an extrapolation of those for gastric GISTs. The purpose of this study was to evaluate the management considerations in surgical patients with GEJG.

Aim: To evaluate the management considerations in resectable GEJG.

Methods: Patients undergoing surgical resection for GEJG during the period June 2007 till September 2020, formed part of the study group. Data of these patients were retrospectively reviewed from a prospectively maintaineddatabase.

Results: Of the 28 Gastric GIST operated during the study period, 14 were GEJG. All GEGJ patients underwent laparoscopic resection. The risk assessment using College of American Pathologists(CAP) protocol showed high, intermediate, low and very low risk of progression(ROP) in two, three, one and eight patients respectively. Five patients received Imatinib mesylate (IM) as adjuvant therapy. Recurrence was seen in two patients (both with High ROP). At a median follow-up of 91 months, all patients are alive, one with recurrence on IM. 

Conclusion: GEJG accounted for over 50% of gastric GISTs. Laparoscopic sleeve resection was feasible in majority of patients. A preoperative biopsy in patients with lesions >5cm in size would identify patients with HROP. Patients with locally advanced disease or HROP should be treated with neoadjuvant therapy. HROP status appears to be of greater importance than R0 status in determining longterm outcomes in these patients.