Superiority of mucosal incision-assisted biopsy over ultrasound-guided fine needle aspiration biopsy in diagnosing small gastric subepithelial lesions: a propensity score matching analysis

Abstract

Background Gastric subepithelial lesions, including gastrointestinal stromal tumors, are often found during routine gastroscopy. While endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) has been the gold standard for diagnosing gastric subepithelial lesions, alternative open biopsy procedures, such as mucosal incision-assisted biopsy (MIAB) has been reported useful. The aim of this study is to evaluate the efficacy of MIAB for the diagnosis of gastric SELs compared with EUS-FNAB. Methods We retrospectively analyzed medical records of 177 consecutive patients with gastric SELs who underwent either MIAB or EUS-FNAB at five hospitals in Japan between January 2010 and January 2018. Diagnostic yield, procedural time, and adverse event rates for the two procedures were evaluated before and after propensity-score matching. Results No major procedure-related adverse events were observed in either group. Both procedures yielded highly-accurate diagnoses once large enough samples were obtained; however, such successful sampling was more often accomplished by MIAB than by EUS-FNAB, especially for small SELs. As a result, MIAB provided better diagnostic yields for SELs smaller than 20-mm diameter. The diagnostic yields of both procedures were comparable for SELs larger than 20-mm diameter; however, MIAB required significantly longer procedural time (approximately 13 min) compared with EUS-FNAB. Conclusions Although MIAB required longer procedural time, it outperformed EUS-FNAB when diagnosing gastric SELs smaller than 20-mm diameter.

A Case of Myoepithelial Hamartoma: Morphological Variation Supported by OCT4 Expression

“…Mucosal incision-assisted biopsy (MIAB) is powerful method for the diagnosis of subepithelial lesions [ 20 , 21 ]; we might have tried MIAB after EUS-FNA failure, but the patient's symptom got worse, and hence, we decided to have surgery. The lesion was located from the antrum of stomach to the bulbus of duodenum across the pylorus, and distal gastrectomy was selected for the treatment instead of laparoscopic and endoscopic cooperative surgery (LECS) [ 22 ].…”

Mucosal Incision-Assisted Endoscopic Biopsy as an Alternative to Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy for Gastric Subepithelial Tumor

“…Several similar mucosal incision-assisted biopsy techniques for gastric SETs such as the unroofing technique or single-incision needle-knife biopsy have been previously reported. [6][7][8][9] A prospective comparative study of EUS-FNA/B and unroofing biopsy in Korea reported no significant difference in the diagnostic yield between the two methods. 10 EUS-FNA/B showed a shorter procedure time and more successful diagnosis for the larger SETs ( ≥ 20 mm) as compared with unroofing biopsy.…”

“…6 The diagnostic yield for smaller SETs ( < 20 mm) was higher than EUS-FNA/B. 9 In their analysis, Nakano et al 5 determined that the main reason for the failure to obtain adequate tissues for the diagnosis is the failure to expose the tumor. The important advantage of this technique is that the tumor beneath the mucosa can be directly observed during the biopsy using endoscopic forceps.…”

“…A definitive or suspected diagnosis was possible in 35 of 45 patients (78%). Several similar mucosal incision-assisted biopsy techniques for gastric SETs such as the unroofing technique or single-incision needle-knife biopsy have been previously reported [ 6 - 9 ]. A prospective comparative study of EUS-FNA/B and unroofing biopsy in Korea reported no significant difference in the diagnostic yield between the two methods [ 10 ].…”

“…Although majority of previous studies were small case series, the overall diagnostic yield of the mucosal incision-assisted biopsy for SETs was reported as 89% [ 6 ]. The diagnostic yield for smaller SETs (<20 mm) was higher than EUS-FNA/B [ 9 ]. In their analysis, Nakano et al [ 5 ] determined that the main reason for the failure to obtain adequate tissues for the diagnosis is the failure to expose the tumor.…”