Submucosal Lesions

Endoscopic ultrasonography for gastric submucosal lesions

“…A number of studies have reported on the tissue acquisition yield and the accuracy rates of EUS-FNA. Results vary between 50% and 93% [12,17,[19][20][21] and seem to be influenced by various factors including the lesion's size (diagnostic rate for GISTs < 2cm, 2-4cm and 4cm or more were 71%, 86% and 100%, respectively) [19] , cytological versus histological assessment [12] and needle size. Recently, newer advanced types of needle aiming at larger specimens or offering other advantages have become available.…”

“…About 10-30% of GISTs have a malignant behavior. However, it should be stressed that according to the current suggested terminology for GISTs, the diagnoses "benign" or "malignant" should be avoided, due to the inherent malignant potential of all GISTs and that definitions including "low", "intermediate" or "high" risk are preferred instead [7,8,12,20] . As previously mentioned, there is lack of evidence on treatment algorithms, when encountering possible gastric GISTs at endoscopy.…”

“…second or forth wall layer) and is us- ually hypoechoic or of mixed echogenicity, including anechoic structures that correspond to ductal formations (Figure 3B). Because of their endosonographic appearance they may cause difficulties in differential diagnosis from carcinoid tumors, which have similar endosonographic characteristics [7,8,12,24,25] .…”

“…The most frequent myogenic tumors (leiomyomas) are characteristically located in the second or forth echo-poor layer; they have an echopoor pattern, and are more or less homogeneous and more or less well demarcated. Other lesions (granular-cell tumors, aberrant pancreas, fibroma, lipoma) have different echo patterns and usually originate from the third, echo-rich layer (submucosa), though sometimes from other layers as well (see the relevant paragraphs that follow) [7,12,13] . The identification of large SMTs can also be achieved by other imaging modalities such as barium studies, CT, MRI and even careful transabdominal ultrasound scanning with gastric water filling, the later being dependent on the experience of the examiner.…”

“…compression on the gastric wall from the outside versus a tumor deep in the wall, under the overlying normal mucosa and if so, a benign or a malignant tumor requiring treatment). The physicians armamentarium for successfully answering these questions and adequately treating the affected patients includes transabdominal ultrasonography, CT and MRI scans, as well as diagnostic EUS carried out when indicated by EUS-guided fine-needle aspiration (EUS-FNA), (leading to treatment options such as close follow-up, endoscopic resection or surgical removal) [12] .…”