Using Forceps Biopsy after Small Submucosal Dissection in the Diagnosis of Gastric Subepithelial Tumors

Abstract

The current tissue sampling techniques for subepithelial tumors (SETs) of the gastrointestinal (GI) tract have limited diagnostic efficacy. We evaluated the diagnostic yield and safety of forceps biopsies after small endoscopic submucosal dissection (SESD biopsies) in the diagnosis of gastric SETs. A total of 42 patients with gastric SETs > 10 mm were prospectively enrolled between May 2013 and October 2014. A dual knife was used to incise the mucosa and submucosa and forceps biopsies were then introduced deep into the lesion. To compare SESD biopsies with EUS-FNA, we used the retrospective data of 30 EUS-FNA cases. The diagnostic yield of SESD biopsies was comparable to that of EUS-FNA (35/42, 83.3% vs. 24/30, 80.0%, P = 0.717). The mean procedure time of SESD biopsies was shorter than that of EUS-FNA (10 vs. 37 minutes, P < 0.001). There were no procedure-related adverse events in the both group. The pathological diagnoses in SESD biopsies group included 15 leiomyomas, 7 GISTs, 10 heterotopic pancreases, 2 lipomas, and one other lesion. SESD biopsies are an easy, effective and safe technique for the diagnosis of gastric SETs and its diagnostic yield is comparable to that of EUS-FNA. This technique may be a reliable alternative to conventional EUS-FNA (Clinical trial registration No. KCT0000730).

Diagnostic yield of deep biopsy via endoscopic submucosal dissection for the diagnosis of upper gastrointestinal subepithelial tumors: a systematic review and meta-analysis

“…Higher diagnostic yields with DB via ESD may occur because the size of the tissue sample is sufficient for IHC testing, even with smaller lesions. Additional benefits with GI SETs, such as the shorter procedure time (10 vs. an average of 39 min for EUS-FNA), prevention of repeat procedures or unnecessary surgical exploratory laparotomy, and earlier initiation of a treatment plan based on biopsy results, make DB via ESD a favorable approach [5,7,15,16,19].…”

“…It provided adequately sized tissue samples to determine the mitotic activity with >5 mitoses/50 high power field diagnosing malignant activity and a higher rate of recurrence, as well as for IHC staining. Tae et al pointed out that the biopsies from EUS-FNA had a mitotic disparity compared to the tissue from Study Kobara et al [13] Jung et al [16] Vaicekauskas et al [5] Kobara et al [18] Lee et al [17] Overall (I^2 = 0.00%, P = 0. the surgically resected SETs, indicating gratuitous resections in 46% of the SETs [7]. Jung et al point out that, given the heterogeneous distribution of mitotic activity, biopsies should be obtained from the area with the most mitotic activity, possible with DB via ESD [16].…”

“…Tae et al pointed out that the biopsies from EUS-FNA had a mitotic disparity compared to the tissue from Study Kobara et al [13] Jung et al [16] Vaicekauskas et al [5] Kobara et al [18] Lee et al [17] Overall (I^2 = 0.00%, P = 0. the surgically resected SETs, indicating gratuitous resections in 46% of the SETs [7]. Jung et al point out that, given the heterogeneous distribution of mitotic activity, biopsies should be obtained from the area with the most mitotic activity, possible with DB via ESD [16]. A prospective study of 87 patients by Tae et al demonstrated that none of the patients in the DB via ESD group had unnecessary surgery, while in the EUS-FNA group, 42.9% of the patients had unneeded surgical procedures as the resected tissue was ultimately judged to be benign [7].…”

“…In our study population, the overall pooled diagnostic yield of DB via ESD for upper GI SETs was 95% (95%CI 4, I 2 =97%). A majority of the upper GI SETs were located in the stomach (96%, 95%CI 83.77-100, I 2 = 84.6%), followed by the esophagus (2.18%, 95%CI 0.00-10.20, I 2 =77.34%) and Jung et al [16] Vaicekauskas et al [5] Kobara et al [18] Kataoka et al [15] Tae et al [7] Lee et al [17] Overall (I^2 = 78.20%, P = 0.00) Figure 2 Forest plot depicting overall diagnostic yield of deep biopsy via endoscopic submucosal dissection duodenum (1.09%, 95%CI 0.00-4.67, I 2 =36.02%), while none were detected by the gastroesophageal junction within our population (n=209).…”

“…All of them were full publications and in original manuscript form. Of the 209 patients, 94 (44.9%) were male and 115 (55.1%) were female, and their mean age was 57.3 years (range: 22-88 years) [5,7,13,[15][16][17][18]. Details of these studies are shown in Table 1.…”