Upfront unroofing of subepithelial lesions using cold snare in the upper and lower gastrointestinal tract: a...

Subepithelial lesions (SELs) are frequently encountered in the upper and lower gastrointestinal (GI) tracts during routine endoscopy. As a significant proportion of SELs harbor malignant potential, a definitive diagnosis with tissue sampling should be sought in most patients. However, small SELs (<20 mm) represent a clinical challenge because endoscopic ultrasound-guided tissue acquisition may not be as efficient under these circumstances. Furthermore, mucosal incision biopsies require equipment that is not universally available.

We retrospectively investigated the diagnostic yield and safety of cold snare unroofing in an observational cohort.

A total of 71 SELs (41 in the upper GI tract and 30 in the lower GI tract) with a median size of 10 mm (range, 3-60 mm) were included. Unroofing resulted in a histologic diagnosis in 85% (n=60) of cases, with no further diagnostic procedures or surveillance required in 88.3% (n=53/60). The final diagnoses consisted of 10 different etiologies, including three GI stromal tumors, one neuroendocrine tumor, and 44 lipomas. No significant complications, such as bleeding or perforation, were observed.

Cold snare unroofing represents an efficient and easy method for characterizing small SELs in the upper and lower GI tracts, offering a valuable alternative to mucosal incision-assisted biopsy (MIAB) and endoscopic ultrasound with fine-needle biopsy.