Abstract
BackgroundGastric subepithelial lesions, including gastrointestinal stromal tumors, are often found during routine gastroscopy. While endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) has been the gold standard for diagnosing gastric subepithelial lesions, alternative open biopsy procedures, such as mucosal incision-assisted biopsy (MIAB) has been reported useful. The aim of this study is to evaluate the efficacy of MIAB for the diagnosis of gastric SELs compared with EUS-FNAB.MethodsWe retrospectively analyzed medical records of 177 consecutive patients with gastric SELs who underwent either MIAB or EUS-FNAB at five hospitals in Japan between January 2010 and January 2018. Diagnostic yield, procedural time, and adverse event rates for the two procedures were evaluated before and after propensity-score matching.ResultsNo major procedure-related adverse events were observed in either group. Both procedures yielded highly-accurate diagnoses once large enough samples were obtained; however, such successful sampling was more often accomplished by MIAB than by EUS-FNAB, especially for small SELs. As a result, MIAB provided better diagnostic yields for SELs smaller than 20-mm diameter. The diagnostic yields of both procedures were comparable for SELs larger than 20-mm diameter; however, MIAB required significantly longer procedural time (approximately 13 min) compared with EUS-FNAB.ConclusionsAlthough MIAB required longer procedural time, it outperformed EUS-FNAB when diagnosing gastric SELs smaller than 20-mm diameter.
Highlights
Gastric subepithelial lesions (SELs) are often found incidentally during routine gastroscopy, and such lesions are reportedly found in approximately 0.4%–3% of patients who undergo the procedure [1] [2] [3]
Both procedures yielded highly-accurate diagnoses once large enough samples were obtained; such successful sampling was more often accomplished by mucosal incision-assisted biopsy (MIAB) than by EUS-FNAB, especially for small SELs
The diagnostic yields of both procedures were comparable for SELs larger than 20-mm diameter; MIAB required significantly longer procedural time compared with EUS-FNAB
Summary
Gastric subepithelial lesions (SELs) are often found incidentally during routine gastroscopy, and such lesions are reportedly found in approximately 0.4%–3% of patients who undergo the procedure [1] [2] [3]. While endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) is considered the gold standard for histologically evaluating gastric SELs, with small SELs, it is sometimes difficult to obtain samples large enough for histological analysis, even when using more recently-developed FNAB needles or newly developed forward-viewing endoscopes. While 83–100% of EUS-FNAB samples were reportedly adequate for cytological evaluations, only 50–83% of such samples were accepted for further histological evaluation [7] [8]. If FNAB does not provide adequate samples or EUS systems are not available, it is very difficult to diagnose SELs, histologically
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