Accuracy of EUS in the evaluation of small gastric subepithelial lesions

Background

EUS combined with endoluminal resection techniques is increasingly used to provide a definitive diagnosis of small gastric subepithelial lesions seen on standard upper endoscopy.

Objective

To evaluate the accuracy of EUS in diagnosing small gastric subepithelial lesions by using histology as the criterion standard.

Design

A retrospective study.

Setting

Academic tertiary care center.

Patients

A total of 22 patients (15 women, mean age 62.2 years) with an endoscopically resected gastric subepithelial lesion were included in this 3-year retrospective study.

Main Outcome Measurements

The size, echogenicity, the layer of origin, and presumptive diagnosis were determined by EUS. The diagnostic accuracy of EUS was determined by using histology as the criterion standard.

Results

The mean size of the 22 lesions was 13.6 mm (range 8-20 mm). An endoscopic cap band mucosectomy device was used to resect 16 (72.7%) lesions, whereas 6 (27.3%) were resected with a saline solution–assisted and snare technique. Using histology as a criterion standard, we found that the accuracy of the EUS diagnosis was 10 of 22 (45.5%). EUS alone had an accuracy rate of 30.8% and 66.7%, respectively, in the diagnosis of neoplastic and non-neoplastic lesions.

Limitations

A single-center, retrospective analysis.

Conclusion

EUS imaging had a low accuracy rate in the diagnosis of gastric subepithelial lesions, and endoscopic submucosal resection should be performed to provide a histologic diagnosis. Resection of small subepithelial lesions of 20 mm or less can be accomplished en bloc with an endoscopic cap band mucosectomy device.

Abbreviations: ESMR, endoscopic submucosal-mucosal resection, GIST, GI stromal tumor, GSL, gastric subepithelial lesion, MALT, mucosa-associated lymphoid tissue