Efficacy of deep biopsy for subepithelial lesions in the upper gastrointestinal tract.

Abstract

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.

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

“…We performed a systematic review of studies that examined DB via ESD in the diagnosis of GI SETs and found that they demonstrated a high overall diagnostic yield. A subset analysis Current guidelines dictate that GI SETs 20mm require resection, in view of their high probability of malignancy, while GI SETs <20mm are considered benign and EUS surveillance or resection is recommended [5,7,13,15,19]. Factors with high malignancy potential are GI SETs located in the upper or middle portions of the stomach, or when they originate from the muscularis propria level [13,15].…”

“…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.…”

“…IHC testing possesses the 2-pronged utility of confirming the diagnosis of GIST and differentiating it from other hypoechoic SETs of varying malignancy potential, such as carcinoid tumors or schwannomas [5,6]. However, the quality of the biopsy is a major determinant of the diagnostic yield, which in turn dictates the type of treatment, surveillance and expected rate of recurrence, while deterring unnecessary interventions based on a low-yield biopsy [7].…”

“…An emerging alternative to the current standard is a deep biopsy (DB) via endoscopic submucosal dissection (ESD), which has demonstrated a high diagnostic yield at about 95%, even with lesions smaller than 20 mm [5,7,10,11]. It is generally an outpatient procedure that begins with epinephrine in saline being injected into the submucosal layer of the visible lesion.…”