Endoscopic characteristics and management of Subepithelial Lesions in VideoGastascopie

Abstract

Background: Subepithelial lesions (SELs) are incidental findings on endoscopies. Some have evil potential.
Aim: Assess the prevalence, endoscopic characteristics, and diagnostic/therapeutic management of Sub-epithelial lesions (SELs) in video-gastroscopies (VGC).
Materials and methods: All VGC for January 2011-June to 2020 were included, and cases with missing data were excluded. The following was recorded where a SELS was identified: indication, age, sex, size, location and histology, findings from endoscopic ultrasonography (EUS), fine needle aspiration (FNA), and surgical resection.
Results: 55 SELS were evidenced in 7,983 patients (0.7%). 72% were women; the most common indication was dyspepsia (26%). The most frequent location was in the stomach (74%). The mean size was 16 mm (5-50 mm), and half were smaller than 10 mm. Seven presented ulcerated mucous, four were in the gastric body, and 86% were referred for gastrointestinal bleeding/anemia. In 26 cases, 55 (48%) standard biopsies were performed, and 6 of the 55 (11%) biopsies on biopsies cases with no diagnostic yield. EUS was performed in 11% of them, all larger than 10 mm: 2 ectopic pancreases, one lesion-compatible leiomyoma, two lesions of the muscularis propria (leiomyoma / GIST), and one extrinsic compression. No FNA was performed. All LSEs were managed conservatively.
Conclusions: This is the first national study on the prevalence of SELS in the upper gastrointestinal tract and was comparable to other series. The diagnostic yield of the biopsy was null. In most cases, the lesions were managed according to the recommendations of international guidelines.