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Abstract
Abnormal thickened lesions of the gastric wall are usually covered with normal mucosa. Conventional endoscopic biopsies often do not yield sufficient positive histological results for clinical treatment. To increase the rate of diagnosis of conventional endoscopic biopsy-negative gastric wall thickening, we used an endoscopic submucosal dissection (ESD)-like sampling method under endoscopic ultrasound (EUS) guidance to obtain tissue of gastric wall-thickening lesions. Between 2012 and 2016, patients with gastric wall thickening (as identified by computed tomography (CT), EUS or other imaging methods that showed no positive findings in repeating conventional endoscopic biopsy) underwent via mucosa incision EUS-guided sampling. Final diagnosis was determined after surgical or biopsy pathology. A total of 10 patients with gastric wall thickening were included in this study. Eight cases received definite results, whereas in two cases the biopsy results were ambiguous and in these two patients poorly differentiated adenocarcinoma was determined by postoperative pathology. The results of the cases presented in this study demonstrated that via mucosa incision EUS-guided sampling provided a complementary option for the diagnosis of conventional endoscopic biopsy-negative gastric wall thickening.
Highlights
Abnormal thickening of the gastric wall with or without gastric stenosis is often identified by a computed tomography (CT) scan or endoscopic ultrasound (EUS)
Abnormal thickening of the gastric wall is often identified during a CT scan and/or endoscopy/EUS examination
Gastric wall thickening can only be observed during CT scans when the gastric lumen is not well distended
Summary
Abnormal thickening of the gastric wall with or without gastric stenosis is often identified by a computed tomography (CT) scan or endoscopic ultrasound (EUS). Gastric wall thickening can be caused by benign lesions, including eosinophilic infiltration or Ménétrier’s disease. Because the thickened lesions are usually covered with normal mucosa, a standard endoscopic biopsy often yields negative results. Bite-on-bite biopsy, an endoscopic technique commonly used in clinical settings, is not highly targeted and is associated with uncertain outcomes and a potential risk of perforation. Submucosal lesions are not clearly visible in the endoscopic view, which increases the risk of uncertain outcomes and potential gastric wall perforation. We use via mucosa incision EUS-guided sampling as an ESD-like sampling means under EUS guidance. Adequacy of the tissue sample is guaranteed and the risk of perforation or injury of large submucosal vessels is prevented
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