IntroductionAccurate diagnosis of subepithelial lesions (SELs) in the gastrointestinal tract depends on a variety of methods: endoscopy, endoscopic ultrasound and different types of biopsy. Making an error-free diagnosis is vital for the subsequent application of an appropriate treatment.AimTo evaluate the efficacy of deep biopsy via the endoscopic submucosal dissection (ESD) technique for SELs in the upper gastrointestinal tract.Material and methodsIt was a case series study. Deep biopsy via the ESD technique was completed in 38 patients between November 2012 and October 2014. Thirty-eight SELs in the upper gastrointestinal tract of varying size (very small ≤ 1 cm, small 1–2 cm and large ≥ 2 cm) by means of the ESD technique after an incision with an electrosurgical knife of the overlying layers and revealing a small part of the lesion were biopsied under direct endoscopic view.ResultsDeep biopsy via the ESD technique was diagnostic in 28 of 38 patients (73.3%; 95% CI: 59.7–89.7%). The diagnostic yield for SELs with a clear endophytic shape increased to 91.3%. An evident endophytic appearance of a subepithelial lesion, the mean number of biopsied samples (6.65 ±1.36) and the total size in length of all samples per case (19.88 ±8.07 mm) were the main criteria influencing the positiveness of deep biopsy in the diagnostic group compared to the nondiagnostic one (p = 0.001; p = 0.025; p = 0.008).ConclusionsDeep biopsy via the ESD technique is an effective and safe method for the diagnosis of SELs especially with a clear endophytic appearance in a large number of biopsied samples.

Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy. Aim: Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT. Materials and Methods: The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features. Results: The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63-21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86-1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs. Conclusions: Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.

An 83-year-old woman under intravenous anaesthesia underwent endoscopic submucosal dissection due to early well-differentiated colon cancer with no deep invasion (pT1). Wide perforation in the deep site of excision of the descending colon was identified and an Ovesco clip placed to close the defect. The patient was discharged from the hospital on day 4 after the procedure, with no abdominal pain and no peritoneal signs of inflammation. Follow-up CT and colonoscopy were performed after 6 months, and no recurrence was observed.

Background: Endoscopic submucosal dissection (ESD) was initially developed in Japan for the treatment of early gastric cancer. Meanwhile ESD has become the treatment of choice for mucosal and submucosal lesions of the oesophagus and stomach. Method: We retrospectively reviewed our data on ESD performed in the period from 2007 to 2011 for the treatment of 67 mucosal and 8 submucosal lesions. These procedures were applied for 60 patients (mean age 63.8 years; 37 female and 23 male). Results: In 4 patients, we found more than 1 lesion for which ESD was applied as a treatment procedure. In 3 patients, ESD was repeated for lesion recurrence in the same location. The ESD specimens were classified as having tumour-free margins in 64 (95.5%) cases; however, during follow-up we identified 7 (10.4%) patients with recurrent lesions, including 3 cases of recurrent hyperplastic polyps, 1 case of early gastric cancer located in the cardia region of the stomach, and 1 case of recurrent flat tubular adenoma in the antral part of the stomach. We experienced 6 cases (8.9%) of delayed post-procedural bleeding all of which were successfully controlled endoscopically. In 5 cases (7.5%), perforation complications occurred. Conclusion: Our first experience with ESD was not all smooth: while the complication rate did not exceed 10%, it was markedly higher than that stated in Eastern literature. We would like to put this down to the learning curve phenomenon. The close cooperation between gastroenterologists and abdominal surgeons was very important and will play a vital role for technological innovations and safety in abdominal medicine in the future.

Evaluation of upper endoscopy, endoscopic ultrasound and deep biopsy diagnostic criteria of subepithelial upper gastrointestinal tract lesions