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AGA Clinical Practice Update on Management of Subepithelial Lesions Encountered During Routine Endoscopy: Expert
Kaveh Sharzehi1, Amrita Sethi2, Thomas Savides3
1Oregon Health and Science University, Portland, Oregon.
Summary
Diagnosing subepithelial lesions (SEL) involves various endoscopic biopsy techniques. Endoscopic ultrasound (EUS) is crucial for indeterminate lesions, guiding management based on size, pathology, and symptoms.
Area of Science:
- Gastroenterology and Endoscopy
- Gastrointestinal Pathology
- Oncology
Background:
- Subepithelial lesions (SEL) of the gastrointestinal tract present diagnostic challenges.
- Accurate characterization is essential for appropriate patient management and risk stratification.
- Traditional biopsy methods may be insufficient for definitive diagnosis of certain SEL.
Framework:
- Utilizing forceps, deep-well, or tunnel biopsies for initial SEL assessment.
- Employing endoscopic ultrasound (EUS) as the primary modality for indeterminate or non-diagnostic SEL.
- Leveraging EUS-guided fine-needle aspiration (FNA) or biopsy (FNB) for submucosal and muscularis propria lesions.
Implementation:
- Sampling submucosal SEL via tunnel biopsies, EUS-FNA/FNB, or advanced endoscopic techniques.
- Differentiating mesenchymal tumors like GIST and leiomyomas from muscularis propria SEL using FNB/FNA and histopathology.
- Considering endoscopic resection for symptomatic, ulcerated, or bleeding SEL, or large gastric GIST (>2 cm).
Implications:
- Tailored management strategies based on SEL size, histopathology, malignant potential, and symptoms.
- Surveillance with EUS for smaller muscularis propria SEL (<2 cm) is recommended.
- Certain benign-appearing SEL (lipoma, pancreatic rest) with normal biopsies require no further follow-up.
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