The Role of Endoscopic Ultrasound in the Diagnostic Assessment of Subepithelial Lesions of the Upper Gastrointestinal Tract

Abstract

IntroductionThe identification of subepithelial lesions is a relatively frequent finding at endoscopy however their natural history is not well known. Our aim was to analyze the role of endoscopic ultrasound (EUS) in the diagnostic approach of subepithelial lesions of the upper gastrointestinal tract.MethodsRetrospective study which included 324 patients undergoing upper radial EUS for evaluation of subepithelial lesions from 2008 to 2014. The EUS features, presumptive diagnosis and management decision were analyzed.Results324 patients included, 60% with gastric subepithelial lesions, 28% oesophageal and 12% from the duodenum. Based on EUS features the presumptive diagnosis was: 25% gastrointestinal stromal tumor, 21% lipoma, 19% leiomyoma, 17% pancreatic rest, 7% submucosa cysts, 1% granular cell tumors, 1% carcinoids, 1% mucosa lesions and 8% not defined. After EUS the suggested approach was no follow-up in 45%, follow-up with re-examination with EUS in 35% and additional tissue sampling or endoscopic/surgical resection in 20%. The latter was based on EUS features of risk at the diagnosis (53%), such as size ≥2 cm, hypoechogenicity, heterogeneity, lobulation, calcifications, cystic component and regional adenopathies; impossibility to define a presumptive diagnosis (39%) or EUS features change at follow-up (8%). The combination of multiple features correlated with a higher probability of this recommended strategy (p < 0.001), in 100% when 4 or more features were present. Among the 33 patients who underwent fine needle aspiration, in 66% the result was inconclusive. During follow-up, none of the patients who were managed with surveillance radial EUS presented complications.ConclusionEUS is the method of choice in the study of subepithelial lesions of the upper gastrointestinal tract, in most cases defining a diagnosis. The need for a definitive diagnosis or therapeutic approaches can be based on ultrasound risk features, presented, in the majority, at presentation. This study shows that EUS is capable of safely and accurately define those subepithelial lesions that can be managed only with surveillance ultrasound while waiting for better results with fine needle aspiration.

Role of endoscopic ultrasonography for differential diagnosis of upper gastrointestinal submucosal lesions

“…EUS can visualize SMLs of the upper digestive tract and provide information regarding the layered structure of the digestive tract wall, the originating layer of the lesions, and the relationship between the lesion and the surrounding tissues, the peripheral lymph nodes and adjacent organs. Moreover, EUS-FNA/FNB can further help to obtain cells or tissues for pathology [ 2 , 3 , 7 ]. Therefore, EUS has become the most effective method for the diagnosis of SML.…”

“…The final pathology suggested that stromal tumors and leiomyomas were the most common types of SMLs, consistent with the report by Dias et al . [ 3 ]. Stromal tumors were more common in the stomach, while leiomyomas were more common in the esophagus, which is also consistent with previous reports [ 8 ].…”

“…Not only can it be used to observe the morphological structure of the lesions in the cavity, but EUS can also perform real-time scanning to obtain information regarding the wall layer structure of the digestive tract, the originating layer of the lesions, and the relationship between the extent of lesion infiltration and the surrounding tissues, peripheral lymph nodes and adjacent organs. EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) can further help to obtain cells or tissues for pathological confirmation [ 2 , 3 , 7 ]. In this study, we reviewed and compared the distribution, size, endoscopic features, and pathological results of SMLs to determine the diagnostic value of EUS for SMLs.…”

The Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients with Endoscopic Biopsy Negative Upper Gastrointestinal Lesions

“…EUS alone has also been used to study these lesions. Castro et al 7 found EUS alone to be extremely valuable in the initial diagnosis of subepithelial lesions, with 45 percent of patients requiring no additional testing.…”

Lipomatosis Gástrica

“…Una limitación de las biopsias tomadas durante la endoscopia radica en que no se obtiene una apropiada representación del tejido graso ubicado en la submucosa (7,21). Otra herramienta de diagnóstico es la ultrasonografía endoscópica, ya que permite evaluar la capa donde se origina el tumor y se pueden realizar biopsias de la submucosa (2,4,22). En cuanto al tratamiento de elección, aún no existe un acuerdo para establecer una guía o tratamiento estándar, principalmente porque las lesiones son asintomáticas y por la baja incidencia que presenta esta condición.…”