Clin Endosc.  2016 May;49(3):216-219. 10.5946/ce.2016.064.

Advances in the Management of Upper Gastrointestinal Subepithelial Tumor: Pathologic Diagnosis Using Endoscopy without Endoscopic Ultrasound-Guided Biopsy

• Lee HL

• KMID: 2165013
• DOI: http://doi.org/10.5946/ce.2016.064

Abstract

Until now, biopsy methods for subepithelial tumors (SETs) have focused on endoscopic ultrasound (EUS)-guided biopsy; however, these methods have several limitations. We devised a simple method for pathologic diagnosis of SETs. SETs are occasionally diagnosed during endoscopy, and lesions are generally small and asymptomatic. It can be challenging to decide on a management plan for large asymptomatic SETs. EUS imaging provides information regarding the size, layer, and echo pattern of the lesions. Patient management plans have traditionally been determined based on EUS images, whereby the endoscopist chooses to either monitor or remove the tumor. However, EUS alone cannot diagnose and evaluate upper gastrointestinal SETs with high accuracy. As sufficient tissue samples are required for the accurate diagnosis of SETs, EUS-guided biopsy techniques such as EUS fine-needle aspiration and trucut biopsy are currently used. However, these methods have a relatively low diagnostic accuracy and do not always provide information upon immunohistochemical staining. Endoscopists can easily detect a submucosal mass after creating an iatrogenic mucosal ulcer, after which tissue sampling is performed by using endoscopic biopsy. Furthermore, pathologic results can differentiate between benign and premalignant lesions. Here, we introduce a simple method for the pathologic diagnosis of SETs.

Keyword

Subepithelial tumor; Diagnosis; Endoscopy

MeSH Terms

Biopsy*
Biopsy, Fine-Needle
Diagnosis*
Endoscopy*
Humans
Methods
Ulcer
Ultrasonography

Figure

• 

  Fig. 1. Deep biopsy technique. (A) The esophageal subepithelial tumor. (B) Endoscopic ultrasound finding showed a hypoechoic mass on proper muscle layer. (C) Submucosal injection. (D) About 10 mm hole was made using a knife. (E) Through the dissected area, multiple endoscopic biopies were performed using biopsy forceps. (F) Clips were applied to the incision site to close and secure the area.

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