Role of endoscopic ultrasonography for differential diagnosis of upper gastrointestinal submucosal lesions

1. In a group of patients with upper gastrointestinal submucosal lesions, endoscopic ultrasonography demonstrated good diagnostic value in specific types of lesions.

Evidence Rating Level: 2 (Good)

Upper gastrointestinal submucosal lesions (SMLs) are one of the most common lesions found during endoscopy. However, differentiating pathological types via endoscopy can be challenging. Endoscopic ultrasonography (EUS) is a useful tool that can be used for evaluation of the upper gastrointestinal SMLs. Therefore, this retrospective study aimed to review the  distribution, size, endoscopic features, and pathological results of SMLs to evaluate the diagnostic value of EUS. 231 participants diagnosed with SMLs were included in this study (mean [SD], 51.89 [11.91] years; 44% male). All patients underwent a routine endoscopy and EUS to confirm the location of the SML. Additionally, all participants underwent a SML resection so that it could undergo pathological and immunohistochemical examination. Diagnostic accuracy rates were confirmed by comparing the number of consistent diagnoses between pathology and EUS. It was found that the diagnostic accuracy of EUS for stromal tumors was 80.4% and for leiomyomas was 68.0%. The study also divided data into two groups; one in which the EUS and pathological diagnosis were the same and the other in which they were different. It then assessed Differences regarding patient age, gender, lesion diameter, location, and origin were compared between the two groups. The results demonstrated that the diagnostic accuracy of EUS was highest for lesions located in the muscularis mucosa compared (muscularis mucosa vs. muscularis propria, p < 0.001; muscularis mucosa vs. submucosa, p < 0.001; muscularis propria vs. submucosa, p = 0.001). Therefore, the study concluded that the EUS demonstrates good diagnostic value for lesions originating from the muscularis mucosa. However, since this was a single-center, retrospective study, additional research is needed to validate these results.

Click to read the study in BMC Gastroenterology

Image: PD

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