Introduction
The increasing number of performed gastroscopies worldwide has lead to higher detection rates of the subepithelial lesions (SELs) of the upper gastrointestinal tract. This study aims to describe the role of endoscopic ultrasonography (EUS) in the diagnosis and management of SELs at a tertiary public reference hospital in Northern Greece.
Aims & Methods
Records of patients who were referred to the Endoscopy Unit of Theageneio Hospital between 2018 and 2023 for upper EUS evaluation were retrospectively reviewed. We conducted data concerning patient characteristics, SELs features, details of the procedure and the final management of each case. All the examinations were performed by a single operator (DT).
Results
A total of 310 patients, male:130 and female:180, with a median age of 59 (range:17-86) were referred to EUS examination. EUS showed extraluminal compression in 16 cases (5.2%), gastric folds in 8 cases (2.6%), vascular structure in 8 cases (2.6%), and in 26 patients (8.4%) no lesion could be identified. A total of 252 (81.3%) patients had confirmed SELs. The lesion's location was: gastric body/corpus in 40.0% (101/252), antrum 34.5% (87/252), duodenum 15.1% (38/252), esophagus 10.3% (26/252). Regarding the size of the lesion in 31.7% of the cases (80/252) was <10mm, 41.3% (104/252) 10-19mm and in 27% (68/252) was >20mm. The most common EUS features were the following: regular borders 98.8% (249/252), hypoechoic lesions 67.5% (170/252), homogenous 77.8% (196/252), without vascularity 90.5% (228/252), and 69.5% (155/252) were originating from the third layer. Sixty-nine SELs (69/252, 27.4%) were malignant or had malignant potential as defined by the EUS findings. More specifically, forty-three patients (43/69, 62.3%) were referred for surgical resection. Twenty-three patients (23/69, 33.3%) were referred for further radiological evaluation and one patient (1/69, 1.4%) was referred for endoscopic resection. Endoscopic reassessment was recommended in 155 patients (155/252, 61.5%). Only one patient had persistent regurgitation, as an examination-related complication, probably due to the periprocedural
anesthesia that led to discontinuation of the examination.
Conclusion
EUS is a practical and safe tool for characterizing and assessing the features and malignant potential of SELs. In our center we could identify the malignant or potential malignant lesions and refer them to surgery.
References
1)Deprez, P. H., Moons, L. M., O’Toole, D., Gincul, R., Seicean,A.,Pimentel‐Nunes,P.,Fernández,Esparrach,G.,Polkowski,M.,Vie
th, M., Borbath, I., Moreels, T. G., Van Dijkum, E. N., Blay, J., & VanHooft, J. E. (2022). Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 54(04),412–429. https://doi.org/10.1055/a-1751-5742
Disclosure
Nothing to disclosure
