Yield of tissue sampling for submucosal lesions evaluated by EUS

Area of Science:

• Gastroenterology
• Endoscopic Ultrasound (EUS)
• Gastrointestinal Pathology

Background:

• Endoscopic ultrasound (EUS) is frequently used to evaluate submucosal nodules and large gastric folds.
• Obtaining a tissue diagnosis for these lesions can be challenging due to the low yield of traditional forceps biopsies.

Purpose of the Study:

• To compare the diagnostic yield of EUS-guided endoscopic submucosal-mucosal resection (ESMR) versus jumbo biopsy for submucosal nodules and large gastric folds.
• To assess the complication rates associated with each procedure.

Main Methods:

• Retrospective review of EUS procedures performed between March 1997 and January 2002.
• Inclusion of patients who underwent either ESMR (n=45) or jumbo biopsy (n=36) for submucosal lesions or large gastric folds.
• ESMR was performed using an electrosurgical snare or a cap-fitted endoscopic mucosal resection device.

Main Results:

• Endoscopic submucosal-mucosal resection achieved a diagnostic yield of 89% (40/45), significantly higher than the 42% (15/36) yield from jumbo biopsy (p < 0.001).
• A total of 9 complications were reported: 7 instances of bleeding, 1 case of chest pain/odynophagia, and 1 case of oversedation.
• Complications, including bleeding requiring hospitalization or transfusion, were more frequent in the ESMR group.

Conclusions:

• Endoscopic submucosal-mucosal resection demonstrates a superior diagnostic yield compared to jumbo biopsy for evaluating submucosal gastric lesions and large gastric folds.
• While ESMR is more effective diagnostically, clinicians should be aware of its potentially higher complication rate.