Long-term prognosis and risk factor-based surveillance strategy for patients with small gastric subepithelial lesion...

Initial surveillance strategy and subsequent monitoring for small gastric subepithelial lesions (SELs) lack a consensus. This study aimed to investigate the risk factors and performance of predictive markers for lesions requiring surgical intervention in patients with small gastric SELs.

We retrospectively reviewed data of patients who underwent EUS at least twice between 2010 and 2023. Group S1 was defined as patients with a ≥20% increase in size from the initial EUS. The S1 was further divided into 2 groups according to requiring surgical intervention (S2 and S3).

Of the 476 patients, 106 (22.2%) had increase in size by ≥20% compared with the initial EUS (S1). The mean follow-up duration in the S1 was 70.2 months. Seven (1.5%) and 38 (8.0%) lesions were observed to have increased in size and were confirmed as gastrointestinal stromal tumors, respectively (S2). Lesions in the lesser curvature (odds ratio [OR]: 6.0, 95% confidence interval [CI]: 2.087-17.148, P < 0.001) and size of ≥12.8 mm (OR: 4.2, 95% CI: 2.083-8.542, P < 0.001) were risk factors for S2. Lesion size ≥12.8 mm is a key risk factor requiring timely intervention based on the Kaplan-Meier analysis. An increasing rate (0.7 mm/yr) showed superior performance as a predictive risk factor for S2 than having a lesion size ≥12.8 mm (area under the receiver-operating characteristic curve: 0.887 vs. 0.734, P < 0.001).

Although the size of the SELs increased, the classification for group S2 was very important. These results emphasize the necessity for effective follow-up strategies, including timely interventions, for small gastric SELs.