Francisca Dias De Castro1, Joana Magalhães1, Sara Monteiro1, Sílvia Leite1, José Cotter 1,2,3
1Gastroenterology Department, Hospital Da Senhora Da Oliveira, Centro Hospitalar Do Alto Ave, Guimarães, Portugal
2Life And Health Sciences Research Institute (ICVS), School Of Health Sciences, University Of Minho, Braga, Portugal
3ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
ABSTRACT
Introduction
The identication of subepithelial lesions is a relatively frequent “finding at endoscopy however their natural history is not well known. Our aim was to analyse the role of endoscopic ultrasound (EUS) in the diagnostic approach of subepithelial lesions of the upper gastrointestinal tract.
Methods
Retrospective study which included 324 patients undergoing upper radial EUS for evaluation of subepithelial lesions from 2008 to 2014. The EUS features, presumptive diagnosis and management decision were analyzed.
Results
324 patients included, 60% with gastric subepithelial lesions, 28% oesophageal and 12% from the duodenum. Based on EUS features the presumptive diagnosis was: 25% gastrointestinal stromal tumor, 21% lipoma, 19% leiomyoma, 17% pancreatic rest, 7% submucosacysts, 1% granular cell tumors, 1% carcinoids, 1% mucosa lesions and 8% not dened. After EUS the suggested approach was no follow-up in 45%, follow-up with re-examination with EUS in 35% and additional tissue sampling or endoscopic/surgical resection in 20%. The latter was based on EUS features of risk at the diagnosis (53%), such as size ≥ 2 cm, hypoechogenicity, heterogeneity, lobulation, calcifications, cystic component and regional adenopathies; impossibility to define a presumptive diagnosis (39%) or EUS features change at follow-up (8%). The combination of multiple features correlated with a higher probability of this recommended strategy (p<0.001), in 100% when 4 or more features were present. Among the 33 patients who underwent fine needle aspiration, in 66% the result was inconclusive. During follow-up, none of the patients who were managed with surveillance radial EUS presented complications.
LINK: http://www.gastroinsights.pt/media/k2/attachments/gepjg_the_role_of_endoscopic_ultrasound_jul16.pdf
