Are Endoscopic Ultrasonography Imaging Characteristics Reliable for the Diagnosis of Small Upper Gastrointestinal Subepithelial Lesions?

Reddymasu, Savio; Oropeza-Vail, Melissa; Pakseresht, Kavous; Moloney, Brian; Esfandyari, Tuba; Grisolano, Scott; Buckles, Daniel; Olyaee, Mojtaba

doi:10.1097/mcg.0b013e318226af8e

Cited by 23 publications

(15 citation statements)

References 14 publications

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“…It seems that preoperative biopsy of SELs should be performed. Overall, the diagnostic accuracy of EUS in diagnosing SELs using histopathology as a gold standard was 49, 48, 45.5, and 66.7% [18][19][20][21]. The accuracy of EUS was 77.1% for GISTs, 50% for neuroendocrine tumor, 50% for ectopic pancreas, 100% for inflammatory fibroid polyps, and 25% for leiomyomas [21].…”

Section: Discussionmentioning

confidence: 97%

Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 97%

Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

et al. 2019

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“…For these reasons, some patients with such lesions prefer to undergo resection, although the management of small, incidentally discovered GISTs of <2 cm is controversial [19,20]. A histologic diagnosis of these lesions is sometimes needed [19-21]. EUS-guided sampling, deep biopsy, and endoscopic partial resection with the unroofing technique are feasible and effective procedures with which to obtain a definitive pathological diagnosis of subepithelial tumors originating from the muscularis propria [22-26].…”

Section: Discussionmentioning

confidence: 99%

Ligation-assisted endoscopic enucleation for the diagnosis and resection of small gastrointestinal tumors originating from the muscularis propria: a preliminary study

et al. 2013

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BackgroundLigation-assisted endoscopic enucleation (EE-L) was developed for the pathological diagnosis and resection of small gastrointestinal tumors originating from the muscularis propria. The technique combines endoscopic band ligation and endoscopic enucleation. The aim of this study was to evaluate the efficacy and safety of EE-L in the diagnosis and resection of gastrointestinal tumors originating from the muscularis propria.MethodsA total of 43 patients were eligible for inclusion in this study from June 2009 to June 2011. Endoscopic ligation was first performed to force the tumor to assume a polypoid form with a pseudostalk. EE-L was then performed until the tumor was completely enucleated from the muscularis propria. Wound closure was performed using clips and adhesive tissue.ResultsAll 43 tumors were completely enucleated. The mean enucleation time was 7.2 minutes (range, 5–11 minutes). No perforation, massive hemorrhage, or peritonitis requiring further endoscopic or surgical intervention occurred. Histopathology, 19 lesions were identified as gastrointestinal stromal tumors and 24 lesions were identified as leiomyomas. The mean follow-up time was 20.4 months (range, 14–38 months). No recurrence has occurred during the follow-up period.ConclusionsEE-L appears to be a safe, effective, and relatively simple method for the histologic diagnosis and removal of small gastrointestinal tumors originating from the muscularis propria.

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“…Table 28.2 summarizes the typical EUS characteristics of the most commonly encountered subepithelial lesions. However, the diagnostic accuracy of EUS imaging alone is approximately 50 % overall, and only 30 % for lesions proven to be neoplastic in nature, with the majority of incorrect diagnoses occurring with hypoechoic lesions arising from the third and fourth echolayers of the gut wall [8,19,20]. Interobserver variability also limits the accuracy of EUS imaging for lesions other than lipomas, cystic lesions, and extrinsic compression [21].…”

Section: How Accurate Is Eus Imaging For Diagnosing Subepithelial Lesmentioning

confidence: 95%

Subepithelial Lesions

Huang¹,

Saltzman²

2015

ERCP and EUS

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Are Endoscopic Ultrasonography Imaging Characteristics Reliable for the Diagnosis of Small Upper Gastrointestinal Subepithelial Lesions?

Cited by 23 publications

References 14 publications

Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

Ligation-assisted endoscopic enucleation for the diagnosis and resection of small gastrointestinal tumors originating from the muscularis propria: a preliminary study

Subepithelial Lesions

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