Endoscopic ultrasonography for gastric submucosal lesions

Papanikolaou, Ioannis S.; Triantafyllou, Konstantinos; Κourikou, Αnastasia; Rösch, Thomas

doi:10.4253/wjge.v3.i5.86

Cited by 87 publications

(70 citation statements)

References 35 publications

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“…The definitive cytological and/or histological verification of larger gastric GIST is currently achieved in 50%-70% of EUS-guided fineneedle aspiration (FNA) or EUS-guided Trucut punch biopsies [10][11][12][13][14][15] . The histological diagnosis of GIST requires immunohistochemical detection of CD117 and particularly in CD117-negative tumors of DOG1 with the corresponding histomorphological findings.…”

Section: Eus and Eus-fnamentioning

confidence: 99%

“…The correct evaluation of a subepithelial lesion by endoscopic ultrasound relies on an experienced team of endoscopists. Indeed the differential diagnosis of "subepithelial or submucosal lesions" of the stomach is complex and extensive [10,14] . The differential diagnosis has to include cysts, pseudocysts, varices, ectopic pancreatic tissue, leiomyomas, schwannomas, lipomas, lymphomas, gastric polyps, inflammatory fibroid polyps, submucosal metastases, protruding aneurysms, large lymph nodes, granular cell tumors and gastric carcinoids [31] .…”

Section: Endoscopic Surveillancementioning

confidence: 99%

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Management of early asymptomatic gastrointestinal stromal tumors of the stomach

Scherübl

Faiss

Knoefel

et al. 2014

WJGE

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Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. Approximately two thirds of clinically manifest tumors occur in the stomach, nearly one third in the small bowel, and the rest in the colorectal region with a few cases in the esophagus. GIST originate within the smooth muscle layer in the wall of the tubular gastrointestinal tract and grow mostly toward the serosa, far less often toward the mucosa. In the latter case, ulceration may develop and can cause gastrointestinal bleeding as the cardinal symptom. However, most GIST of the stomach are asymptomatic. They are increasingly detected incidentally as small intramural or submucosal tumors during endoscopy and particularly during endoscopic ultrasound. Epidemiological and molecular genetic findings suggest that early asymptomatic GIST of the stomach (< 1 cm) show self-limiting tumorigenesis. Thus, early (< 1 cm) asymptomatic gastric GIST (synonym: micro-GIST) are found in 20%-30% of the elderly. The mostly elderly people with early gastric GIST have an excellent GIST-specific prognosis. Patients with early GIST of the stomach can therefore be managed by endoscopic surveillance.

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Section: Eus and Eus-fnamentioning

confidence: 99%

Section: Endoscopic Surveillancementioning

confidence: 99%

Management of early asymptomatic gastrointestinal stromal tumors of the stomach

Scherübl

Faiss

Knoefel

et al. 2014

WJGE

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“…Lee et al (9) suggest a treatment algorithm for patients with GSL (Figure 3) and the American Gastroenterological Association (7) recommends surgical resection for GSLs from the fourth layer greater than 3 cm, and follow-up with periodic endoscopy and/or EUS for GSLs smaller than 3 cm. All GISTs have malignant potential according to the classification system proposed by the National Institutes of Health Consensus Conference (4) and this is also the case even for small lesions (1,10,14,19) . The authors believe that all GSLs should first be evaluated by endoscopic ultrasound to exclude other evident etiologies (such as lipomas, vascular lesions, pancreatic rest, extra-mural compression) and to determine the most adequate management based on echoendoscopic findings.…”

Section: Discussionmentioning

confidence: 99%

“…Lee et al (9) reported an overall diagnostic rate of 57% with Trucut biopsy (unsuccessful puncture in 14% and inadequate samples in 29% of cases). Considering the technical problems of EUS-FNA and the infrequent metastatic risk in small GISTs smaller than 1 cm, Papanikolaou et al (14) recommended aggressive use of EUS-FNA only for subepithelial hypoechoic tumors of the gastrointestinal tract larger than 1 cm. The diagnostic failure rates for EUS-FNA (17) have described a sensitivity, specificity, and accuracy of 100%, 63%, and 83%, respectively, to predict GIST malignancies using contrast-enhanced harmonic EUS, making this a promising method.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound in the Evaluation of Upper Subepithelial Lesions

Chaves

Meine

Matuguma

et al. 2015

Arq. Gastroenterol.

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-Background -Endoscopic ultrasound is considered the best imaging test for the diagnosis and evaluation of subepithelial lesions of the gastrointestinal tract. Objective -The present study aims to describe the endosonographic characteristics of upper gastric subepithelial lesions and our experience using endoscopic ultrasound for evaluation of such lesions. Methods -Retrospective data study of 342 patients who underwent endoscopic ultrasound evaluation of subepithelial lesions. Results -Lesions of the fourth layer were more common in the stomach (63.72%) than in the esophagus (44.68%) and duodenum (29.03%). In stomach, 81.1% of the lesions ≥2 cm, and 96.5% ≥3 cm, were from the fourth layer. Endosonographic signs that could be related to malignant behavior, such as irregular borders, echogenic foci, cystic spaces and/or size greater than 3 cm were identified in 34 (15.81%) lesions at the first endoscopic ultrasound evaluation. Endoscopic ultrasound-fine needle aspiration did the diagnosis in 21 (61.76%) patients who were submitted a puncture. Three (12.0%) lesions of 25 who were submitted to regular endoscopic ultrasound surveillance increased the size. Conclusion -Stomach is the organ most affected with subepithelial lesions of the gastrointestinal tract and the fourth layer was the most common layer of origin. More than 80% of gastric subepithelial lesions from the fourth layer are ≥2 cm. Endoscopic ultrasound evaluation of subepithelial lesions has been very important for stratification into risk groups and to determine the best management. HEADINGS -Endosonography. Gastrointestinal stromal tumors. Endoscopic ultrasound-guided fine needle aspiration. Biopsy fine-needle.

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“…EUS-FNA is one of the easiest and safest methods to obtain pathological samples for SMTs' diagnosis [9][10][11][12]. However, the diagnosis rate of EUS-FNA is insufficient (about 63%) as the obtained samples are too small to pathologically diagnose the mitotic counts [13].…”

Section: Discussionmentioning

confidence: 99%

Open Biopsy guided by Endoscopic Ultrasonography from a Gastric Submucosal Tumor growing Outside the Stomach

Mori

Kobara

Nishiyama

et al. 2015

JGLD

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Submucosal tunneling bloc biopsy for submucosal tumors growing inside the gastric wall is a safe and reliable method. However, it is difficult for an endoscopist to perform submucosal tunneling bloc biopsy and detect the demarcation line between the proper muscular layer and the capsule layer of submucosal tumors growing outside the gastric wall.A submucosal tumor in the lesser curvature of the stomach was identified in a 74-year-old man by esophagogastroduodenoscopy. Computed tomography revealed hetero-density with partial calcification of the tumor growing outside the gastric wall, that connected to approximately 10 mm of the muscular layer. Almost all of the tumor body was located outside the stomach. After the small connecting area was detected by endoscopic ultrasonography, two markings were placed at the opposite ends of the tumor. The tumor was removed via snare resection between the markings located immediately above the top of the tumor. After the biopsy site was reconfirmed using endoscopic ultrasonography, a large bloc biopsy was conducted. This new "open biopsy under endoscopic ultrasonography" is a simple, safe, and reliable method to obtain samples from any type of submucosal tumor growing inside or outside the stomach.

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Endoscopic ultrasonography for gastric submucosal lesions

Cited by 87 publications

References 35 publications

Management of early asymptomatic gastrointestinal stromal tumors of the stomach

Management of early asymptomatic gastrointestinal stromal tumors of the stomach

Endoscopic Ultrasound in the Evaluation of Upper Subepithelial Lesions

Open Biopsy guided by Endoscopic Ultrasonography from a Gastric Submucosal Tumor growing Outside the Stomach

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