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GIST-EUS shows a heterogeneous hypoechoic lesion of the forth gastric wall layer with lobulation measuring 10 × 6 cm.
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Introduction: The identification of subepithelial lesions is a relatively frequent finding at endoscopy however their natural history is not well known. Our aim was to analyze the role of endoscopic ultrasound (EUS) in the diagnostic approach of subepithelial lesions of the upper gastrointestinal tract.
Methods: Retrospective study which included 3...
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Citations
... From another perspective, EUS is the most effective method for the diagnosis of submucosal lesions. EUS can visualize submucosal lesions of the upper digestive tract and provide information regarding the layered structure of the digestive tract wall, originating layer of the lesions, and relationship between the lesion and surrounding tissues, peripheral lymph nodes, and adjacent organs [15,16]. A retrospective study found that the diagnostic accuracies of EUS were 80.4% for stromal tumors and 68.0% for leiomyomas, with the highest diagnostic accuracy for lesions located in the muscularis mucosa [17]. ...
Objective
To present a study to identify the characteristics of coexisting early gastric cancer (EGC) and benign submucosal lesions, with the aim of reducing the adverse consequences of overdiagnosis and overtreatment.
Methods
In this retrospective study, we searched the endoscopic databases of three tertiary centers. We screened of patients suspected of early gastric cancer submucosal infiltration by conventional endoscopy and ultimately selected for endoscopic submucosal dissection treatment after endoscopic ultrasonography and magnifying endoscopy with narrow-band imaging examination. Patients with coexisting EGC and benign submucosal lesions in histological sections were included. Clinical data and endoscopic images were reviewed. To evaluate the precision of endoscopists’ diagnoses for this type of lesion, eight endoscopists with different experiences were recruited to judge the infiltration depth of these lesions and analyze the accuracy rate.
Results
We screened 520 patients and retrospectively identified 18 EGC patients with an invasive cancer-like morphology. The most common lesion site was the cardia (12/18, 66.67%). The coexisting submucosal lesions could be divided into solid (5/18, 27.78%) and cystic (13/18, 72.22%). The most common type of submucosal lesion was gastritis cystica profunda (12/18, 66.67%), whereas leiomyoma was the predominant submucosal solid lesion (3/18, 16.67%). Ten (55.56%) patients < underwent endoscopic ultrasonography; submucosal lesions were definitively diagnosed in 6 patients (60.00%). The accuracy of judgement of the infiltration depth was significantly lower in cases of coexistence of EGC with benign submucosal lesions (EGC-SML) than in EGC (38.50% versus 65.60%, P = 0.0167). The rate of over-diagnosis was significantly higher within the EGC-SML group compared to the EGC group (59.17% versus 10.83%, P < 0.0001).
Conclusions
We should be aware of the coexistence of EGC and benign submucosal lesions, the most common of which is early cardiac-differentiated cancer with gastritis cystica profunda.
... From another perspective, EUS is the most effective method for the diagnosis of submucosal lesions. EUS can visualize submucosal lesions of the upper digestive tract and provide information regarding the layered structure of the digestive tract wall, originating layer of the lesions, and relationship between the lesion and surrounding tissues, peripheral lymph nodes, and adjacent organs (16,17). A retrospective study found that the diagnostic accuracies of EUS were 80.4% for stromal tumors and 68.0% for leiomyomas (18). ...
Objective
To present a study to identify the characteristics of coexisting early gastric cancer (EGC) and benign submucosal lesions, with the aim of reducing the adverse consequences of overdiagnosis and overtreatment.
Methods
In this retrospective study, we searched the endoscopic databases of three tertiary centers. We screened of patients suspected of early gastric cancer submucosal infiltration by conventional endoscopy and ultimately selected for endoscopic submucosal dissection treatment after endoscopic ultrasonography and magnifying endoscopy with narrow-band imaging examination. Patients with coexisting EGC and benign submucosal lesions in histological sections were included. Clinical data and endoscopic images were reviewed. To evaluate the precision of endoscopists' diagnoses for this type of lesion, eight endoscopists with different experiences were recruited to judge the infiltration depth of these lesions and analyze the accuracy rate.
Results
We screened 520 patients and retrospectively identified 18 EGC patients with an invasive cancer-like morphology. The most common lesion site was the cardia (12/18, 66.67%). The coexisting submucosal lesions could be divided into solid (5/18, 27.78%) and cystic (13/18, 72.22%). The most common type of submucosal lesion was gastritis cystica profunda (12/18, 66.67%), whereas leiomyoma was the predominant submucosal solid lesion (3/18, 16.67%). Ten (55.56%) patients underwent endoscopic ultrasonography; submucosal lesions were definitively diagnosed in 6 patients (60.00%). The accuracy of judgement of the infiltration depth was significantly lower in coexistence with EGC and benign submucosal lesions than in simple EGC (38.50% versus 65.60%, P = 0.0167), especially for inexperienced endoscopists, and the overdiagnosis rate was up to 75.00%.
Conclusions
We should be aware of the coexistence of EGC and benign submucosal lesions, the most common of which is early cardiac-differentiated cancer with gastritis cystica profunda. Endoscopic ultrasonography is a useful modality for diagnosing these coexisting submucosal lesions.
... Symptoms include epigastric pain and/or upper abdominal pain, postprandial fullness, gastric bloating, early satiety, and nausea 7 . Upper GI tract endoscopy is the standard method to diagnose FD, which is also called dyspepsia without ulcer 8 . ...
... For example, if a person who has just recovered from an illness shows the symptoms of dyspepsia, it is a serious warning that the illness is going to relapse. While the food enters the stomach, incomplete digestion would happen in the presence of dyspepsia, potentially endangering a person's physical health 7,8,11 . ...
Association of functional dyspepsia with selected dermatology complaints and sleep disturbances based on traditional Persian medicine Background: Functional dyspepsia (FD) is a common disorder of the upper gastrointestinal tract. Several documents in conventional medicine claim an association between FD, sleep disturbance, and some dermatological conditions, but there is still debate about these relationships. This study aimed to measure the association between FD and some skin problems and sleep indices based on the attitudes of traditional Persian medicine. Methods: This study was carried out on patients with the diagnosis of FD and healthy people. The study population consisted of patients who referred to the gastroenterology clinic of Shiraz University of Medical Sciences (Shiraz, Iran) from July to December 2019. To diagnose dyspepsia, we used Rome III criteria. Skin problems and sleep indices were evaluated using were considered significant. Results: Overall, 160 patients (46 men and 116 women) with FD and 155 healthy individuals (36 men and 119 women) were enrolled in the study. There were significant differences between patients and healthy individuals in terms of dryness of skin (P = 0.001), oily hair, deep sleep, long sleep, insomnia, difficulty sleeping, hand, there were no significant differences between the groups in intermittent sleeping (P = 0.116) and periorbital edema after sleeping (P = 0.195). Conclusions: According to the results of this study, it seems that there is a positive relationship between FD and some dermatological and sleeping indices based on traditional Persian medicine resources.
... Una limitación de las biopsias tomadas durante la endoscopia radica en que no se obtiene una apropiada representación del tejido graso ubicado en la submucosa (7,21). Otra herramienta de diagnóstico es la ultrasonografía endoscópica, ya que permite evaluar la capa donde se origina el tumor y se pueden realizar biopsias de la submucosa (2,4,22). En cuanto al tratamiento de elección, aún no existe un acuerdo para establecer una guía o tratamiento estándar, principalmente porque las lesiones son asintomáticas y por la baja incidencia que presenta esta condición. ...
La lipomatosis gástrica es una enfermedad infrecuente caracterizada por múltiples lesiones tumorales benignas (lipomas), que acorde a su tamaño pueden producir una variedad de síntomas. Por lo general, la enfermedad es documentada incidentalmente en estudios imagenológicos que se realizan para estudiar otras enfermedades y los hallazgos patológicos contribuyen a tener una certeza en el diagnóstico de esta patología. Por el momento, no hay un tratamiento definido para las masas pequeñas y asintomáticas, mientras que para las masas grandes (> 3-4 cm) o sintomáticas se sugiere la resección quirúrgica de las lesiones.
... Most subepithelial lesions are benign at the time of diagnosis, with less than 15% found to be malignant at presentation. However, many of these lesions have the potential for malignant transformation [1][2][3]. There is a broad differential diagnosis of such lesions, which emphasizes the importance of an accurate diagnosis. ...
... With regard to specific clinical indications, the role of EUS and EUS-FNA in the localization staging of luminal gastrointestinal cancers is well known [6]. Due to its high sensitivity and specificity, endoscopic ultrasound has been recognized as an accurate imaging method for the evaluation of SELs in the gastrointestinal tract [1,2,[7][8][9][10]. Echo intensity, homogeneity, and tissue or other material characteristics that reflect ultrasound waves are typically used as diagnostic sonographic standards [11]. ...
... Early endoscopic identification is crucial. Endoscopic ultrasound is the second phase in the assessment of SELs which provides valuable information to guide further management [1]. Moreover, EUS is the diagnostic investigation of choice to differentiate between intramural and extramural lesions and to assess the size, margins, origin layer, lesion echotexture and presence of adjacent lymph nodes, surrounding structures and is significantly more effective than endoscopy, transparietal ultrasonography, and CT scan [16][17][18][19]. ...
Background:
To assess the role of endoscopic ultrasound (EUS) in the diagnosis of upper gastrointestinal subepithelial lesions (SELs) and to investigate EUS combined with a grayscale histogram analysis for the differentiation of leiomyomas and gastrointestinal stromal tumors (GISTs).
Methods:
A retrospective study of 709 patients with upper gastrointestinal SELs was conducted by EUS before endoscopic resection. The EUS findings of SELs and pathological results after endoscopic resection were compared. The EUS images of SELs, particularly, leiomyoma and GIST, were further analyzed via a grayscale histogram to differentiate between the two tumors.
Results:
Of the 709 patients, 47 cases were pathologically undetermined. The diagnostic consistency of EUS with endoscopic resection was 88.2% (584/662), including 185 muscularis mucosa, 61 submucosa, and 338 muscularis propria, respectively. The diagnostic consistency of EUS with pathology was 80.1% (530/662). The gray value of GISTs was significantly higher than that of leiomyomas (58.9 ± 8.3 vs. 39.5 ± 5.9, t = 57.0, P < 0.0001). The standard deviation of leiomyomas was significantly lower than that of GISTs (20.6 ± 7.0 vs. 39.8 ± 9.3, t = 23.7, P < 0.0001). The grayscale histogram analysis of GISTs showed higher echo ultrasound, and the echo of leiomyoma was more uniform.
Conclusion:
EUS is the preferred procedure for the evaluation of upper gastrointestinal SELs. EUS combined with a grayscale histogram analysis is an effective method for the differentiation of leiomyomas and GISTs.
... One proposed management strategy for gastric GI stromal tumors <2 cm in size is surgical resection for lesions with high-risk EUS features and EUS surveillance at 6-month to 12-month intervals for those without these features (9,10) . ...
... submucosal gastrointestinal lesions can be diagnosed through invasive techniques such as endoscopic mucosal resection, or surgical resection (10) . ...
... Dias et al. (10) concluded that EUS is the method of choice in the study of submucosal lesions of the upper gastrointestinal tract, in most cases defining a diagnosis. ...
Background
Although endoscopic ultrasound (EUS) plays a critical role in the management of subepithelial lesions (SEL) of upper gastrointestinal tract many can be classified solely by a thorough upper gastrointestinal endoscopy (UGE) which can reduce the burden of additional studies.
Aims
Analyze the impact of a stepwise approach starting with a second-look UGE before the decision of EUS in patients referred to our center with suspected SEL.
Methods
Retrospective cohort study which included all adult patients referred to our center between 2015 and 2020 with suspected SEL.Second-look UGE evaluated the location, size, color, surface characteristics, movability and consistency of the SEL and bite-on-bite biopsies were performed. Decisions on SEL management and follow-up were collected.
Results
A total of 193 SEL (190 patients) were included. At the index-UGE, stomach was the most frequent location (n = 115;59.6%). Most patients performed a second-look UGE (n = 180; 94.7%). A minority was oriented directly to EUS (n = 8;4.2%) or endoscopic resection (n = 2; 1.1%). In patients who underwent a second-look UGE, SEL were excluded in 25 (13.9%) and 21 (11.7%) did not need further work-up. The remaining patients were submitted to EUS (n = 88;48.9%), surveillance by UGE (n = 44; 24.4%) or endoscopic resection (n = 2; 1.1%).
Conclusion
Systematically performing a second-look UGE, in patients referred with suspected SEL, safely preclude the need for subsequent investigation in approximately one-fourth of the patients. As UGE is less invasive and more readily available, we suggest that a second-look UGE should be the initial approach in SEL management.
Subepithelial lesions (SEL) of the GI tract represent a mix of benign and potentially malignant entities including tumors, cysts, or extraluminal structures causing extrinsic compression of the gastrointestinal wall. SEL can occur anywhere along the GI tract and are frequently incidental findings encountered during endoscopy or cross-sectional imaging. This clinical guideline of the American College of Gastroenterology was developed using the Grading of Recommendations Assessment, Development, and Evaluation process and is intended to suggest preferable approaches to a typical patient with a SEL based on the currently available published literature. Among the recommendations, we suggest endoscopic ultrasound (EUS) with tissue acquisition to improve diagnostic accuracy in the identification of solid nonlipomatous SEL and EUS fine-needle biopsy alone or EUS fine-needle aspiration with rapid on-site evaluation sampling of solid SEL. There is insufficient evidence to recommend surveillance vs resection of gastric gastrointestinal stromal tumors (GIST) <2 cm in size. Owing to their malignant potential, we suggest resection of gastric GIST >2 cm and all nongastric GIST. When exercising clinical judgment, particularly when statements are conditional suggestions and/or treatments pose significant risks, health-care providers should incorporate this guideline with patient-specific preferences, medical comorbidities, and overall health status to arrive at a patient-centered approach.
Objective:To determine the diagnostic accuracy of endoscopic ultrasound guided (EUS) fine needle aspiration in patients who had inconclusive endoscopic biopsies of the same lesion.Methodology: This retrospective study was conducted at Pak Emirates Military Hospital, Rawalpindi, Pakistan from January2018 to July 2020. Patients who underwent EUS guided FNAC were screened. The FNAC results of patients satisfying the inclusion criteria were compared with either a surgical biopsy in patients in whom surgeries were done, while in the remaining patients, EUS FNAC results were compared with a 3 monthsradiological and/or 6 months clinical follow-up. Results: The final diagnosis was defined based on the following criteria: (1) Malignant lesions (n=36), histopathologic diagnosis obtained based on surgery resected samples (n=18) or clinical diagnosis as neoplasm based on clinical follow-up of symptoms (n=30) or radiologic diagnosis based on imaging follow-up at 3 months (n=13) (2) Benign lesions (n=18), benign cytopathologic histopathologic findings and clinical follow-up with no evidence of malignant progression or metastasis.EUS-guided FNA cytology turned out to be malignant in 60 percent (n=36) of the specimens. 30 percent of the samples showed benign epithelial cytology (n=18) while in 10 percentofthe cases (n=6), the tissue samples were deemed insufficient for cytological diagnosis. The accuracy came out to be 66.6 percent (n=10 were true negative), sensitivity 93.4 percent, and specificity 100 percent.Conclusion: EUS guided-FNA cytology of the sub-mucosal upper GI lesions is highly sensitive and specific for upper GI lesions, which are negative on endoscopic biopsies.
Objective
To determine the accuracy of endoscopic ultrasonography (EUS) in the diagnosis of upper gastrointestinal submucosal lesions (SMLs).
Methods
This was a retrospective study involving patients diagnosed with SMLs using EUS and confirmed by histopathology from November 2014 to December 2020 at The Third Xiangya Hospital of Central South University.
Results
A total of 231 patients with SMLs were examined by EUS. Histologically, 107 lesions were stromal tumors, and 75 lesions were leiomyomas. Stromal tumors were mainly located in the stomach (89.7%), and leiomyomas were predominantly seen in the esophagus (69.3%). The diagnostic accuracy of EUS for stromal tumors and leiomyomas was 80.4% and 68.0%, respectively. The diagnostic accuracy was highest for lesions located in the muscularis mucosa. The mean diameter of stromal tumors measured using EUS was significantly larger than that of leiomyomas (21.89 mm vs. 12.35 mm, p < 0.001). Stromal tumors and leiomyomas originated mainly from the muscularis propria (94.4%) and the muscularis mucosa (56.0%), respectively. Compared with the very low-risk and low-risk groups of stromal tumors according to the National Institute of Health guidelines, the intermediate-risk and high-risk groups were more likely to have a lesion > 3 cm ( p < 0.001) and a surface ulcer ( p < 0.01) identified by EUS.
Conclusions
EUS has good diagnostic value for the diagnosis of upper gastrointestinal SMLs based on the lesion size and the muscle layer of origin. The diagnostic accuracy of EUS lesions is related to the origin, and the diagnostic accuracy is greatest in the mucosal muscularis layer. Stromal tumors > 3 cm and a surface ulcer on EUS are likely to be intermediate or high risk for invasion.
