Background and Aims
Accurate diagnosis of small gastric subepithelial tumors (SETs) is essential to assess
their malignant potential. Endoscopic unroofing has been reported to yield sufficient
tissue samples for histologic evaluation. This study aimed to evaluate the safety,
diagnostic yield, and potential therapeutic effects of this technique over time.
Methods
This retrospective analysis of prospectively collected clinical data identified patients
who underwent endoscopic unroofing at the Medical University of Vienna from January
2003 to December 2012. Demographic data, indications for endoscopic unroofing, intraprocedural
adverse events, hospital stay, histologic results, and follow-up procedures were reviewed.
Results
A total of 14 patients (7 men; 7 women; median age, 70 years; range, 51-95 years)
underwent endoscopic unroofing of 14 gastric SETs with a mean diameter of 26 ± 13 mm
at EUS. In 9 of 14 cases, endoscopic unroofing was done exclusively for diagnostic
purposes; in the remaining cases, it was performed with therapeutic intent because
of bleeding from the gastric SETs. Unroofing was technically successful in 13 of 14
cases and revealed 8 cases of GI stromal tumor (GIST) and 1 case each of leiomyoma,
fibroid polyp, glomus tumor, pancreatic rest, and nondiagnostic material at histology.
Intraprocedural bleeding was the only adverse event (4 cases) and could be managed
endoscopically. A follow-up EUS was available (median, 8 months) for 10 of the 14
patients. Notably, most patients showed complete regression of their gastric SETs
after unroofing (on white light and EUS), including the glomus tumor, the leiomyoma,
and 6 of the 8 cases of GIST.
Conclusions
Endoscopic unroofing was safe and had a very favorable diagnostic yield in this study.
Unexpectedly, it led to complete regression in most gastric SETs. Although it is not
an oncologically curative treatment, endoscopic unroofing can be a valuable option
to treat local adverse events in patients unfit for surgical therapy. (Clinical trial
registration number: NCT02587923.)
Abbreviations:
APC (argon plasma coagulation), ESD (endoscopic submucosal dissection), EUS-FNA (EUS-guided FNA), FTER (full-thickness endoscopic resection), GIST (gastrointestinal stromal tumor), SET (subepithelial tumor), STER (submucosal tunneling endoscopic resection)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 21, 2016
Accepted:
April 7,
2016
Received:
January 30,
2016
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Dolak at [email protected]
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
