ENDOSCOPIC MANAGEMENT OF SUBEPITHELIAL LESIONS OF THE STOMACH
Main Article Content
Keywords
endoscopy, endosonography, stomach, gastrointestinal stromal tumors
Abstract
Subepithelial lesions are considered a great concern for doctors, gastroenterologists and endoscopists, since there is a high frequency of diagnosing during the practice of routine endoscopies. Its causes can be due to both intrinsic lesions of the wall of the gastrointestinal tract (benign or malignant) and extrinsic compressions caused by normal or pathological structures. The majority of lesions are of benign origin, however, there is a percentage between 12 to 15% of lesions that could be of malignant origin, so timely diagnosis is of great importance for adequate treatment.
General objective: to describe the different endoscopic techniques for the management of subepithelial lesions of the stomach.
Methodology: literature review. Health databases such as Cochrane, PubMed, Dialnet, Cinahl, Scopus, etc. will be searched. Key words such as "endoscopy", "endosonography", "stomach", "gastrointestinal stromal tumors" will be used in English and Spanish. Boolean operators will be used to improve searches: "AND" and "OR"
References
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9. Ebi M, Nagao K, Sugiyama T, Yamamoto K, Saito T, Kurahashi S, et al. Gastric Plexiform Fibromyxoma Resected Using Nonexposed Endoscopic Wall-Inversion Surgery: A Case Report. Case Rep Gastroenterol [Internet]. 2022 ; 16(1):159-64. Available in: https://www.karger.com/Article/FullText/522411
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12. Chien MM, Lin YH, Chang CC, Chien HY. A Rare Gastric Subepithelial Lesion Removed through Submucosal Tunneling Endoscopic Resection: Case Report and Literature Review. Life [Internet]. 2023; 13(1):179. Available in: https://www.mdpi.com/2075-1729/13/1/179
13. Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, et al. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics. 2023; 13(13):2176.
14. Dorelo R, Taullard A. Prevalence, endoscopic features, and management of subepithelial lesions of the upper gastrointestinal tract. ANFAMED [Internet]. 2020; 7(1). Available in: https://doi.org/10.25184/anfamed2020v7n1a5
15. López-Fuentes J, Flores-Rentería F, Reyes-Aguilar J, Saucedo-Moreno E, Soto-Solís E, Galicia-Gómez T, et al. Diagnostic utility of endoscopic ultrasound in subepithelial lesions of the upper digestive tract. Endoscopy [Internet]. 2020; 32 (Suppl 2). Available at: DOI: 10.24875/END. M20000265
16. Deprez PH, Moons LMG, OʼToole D, Gincul R, Seicean A, Pimentel-Nunes P, et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022; 54(04):412-29.
17. Menon L, Buscaglia JM. Endoscopic approach to subepithelial lesions. Therap Adv Gastroenterol. 2018; 7(3):123-30.
18. Garg R, AlRajjal A, Berri R, Barawi M. Primary Gastric Leiomyosarcoma: a Case Report and Review of the Literature. J Gastrointest Canc. 2020; 51(1):335-40.
19. Lee JC, Curtis D, Williamson JB, Ligato S. Gastric Desmoid Fibromatosis – Report of a Rare Mimic of Gastrointestinal Stromal Tumor. Cureus [Internet]. 2021; Available in: https://www.cureus.com/articles/75847-gastric-desmoid-fibromatosis---report-of-a-rare-mimic-of-gastrointestinal-stromal-tumor
20. Tsai MK, Chen HY, Chuang ML, Chen CW, Jong GP. Gastric Calcifying Fibrous Tumor: An Easy Misdiagnosis as Gastrointestinal Stromal Tumor–A Systemic Review. Medicine. 2020; 56(10):541.
21. Gheorghe G, Bacalbasa N, Ceobanu G, Ilie M, Enache V, Constantinescu G, et al. Gastrointestinal Stromal Tumors—A Mini Review. .JPM. 2021; 11(8):694.
22. Chao L, Torres Y, Barroso L, Cepero M, Cepero-Nogueira N. Value of endoscopic ultrasound in the diagnosis of subepithelial lesions of the gastrointestinal tract. Rev Cub Cir [Internet]. 2018; 7(4). Available in: http://scielo.sld.cu/pdf/cir/v57n4/1561-2945-cir-57-04-e760.pdf
23. Yamamoto K, Ikeya T, Kanomata N, Deshpande GA, Takagi K, Omata F. Three Types of Subepithelial Lesion-Like Gastric Cancer Including a New Entity of Gastric Adenocarcinoma. Case Rep Gastroenterol [Internet]. 2022; 16(2):368-74. Available in: https://www.karger.com/Article/FullText/524792
24. Deprez PH, Moons LMG, OʼToole D, Gincul R, Seicean A, Pimentel-Nunes P, et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022; 54(04):412-29.
25. De Moura DTH, McCarty TR, Jirapinyo P, Ribeiro IB, Flumignan VK, Najdawai F, et al. EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: a large multicenter study. Gastrointestinal Endoscopy. 2020; 92(1):108-119.e3.
26. Chen G, Nie L, Zhang T. An extremely rare case of a gastric accessory spleen: case report and review of the literature. BMC Gastroenterol. 2021; 21(1):275.
27. Moreno-Paquentín E, Molina DC, Sánchez-García J, Arrangoiz-Majul R. Clinical case report of a giant gastrointestinal stromal tumor (GIST) and literature review. Surgeon General.
28. Zhong Z, Xu Y, Liu J, Zhang C, Xiao Z, Xia Y, et al. Clinicopathological study of gastric schwannoma and review of related literature. BMC Surg. 2022; 22(1):159.
29. Gastrointestinal stromal tumors in a hospital in Mexico | Moreno Galeana - España | Revista Cubana de Cirugía [Internet]. Available in: https://revcirugia.sld.cu/index.php/cir/article/view/1127/666
30. Advancements in the Diagnosis of Gastric Subepithelial Tumors [Internet]. Available in: https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl210242
31. Rodríguez-Infante A, Fernández-Martínez D, García-Iglesias E, Rodríguez-Infante A, Fernández-Martínez D, García-Iglesias E. Ectopic pancreas: a very rare intestinal mass. Spanish Journal of Digestive Diseases. 2018; 110(2):127-8.
32. Salceda-Otero JC, Duarte JE, Sabbagh L. Gastric ectopic pancreas of infrequent localization in the muscularis of the mucosa. Rev Gastroenterol Mex. 2018; 76(1):73-8.
33. Blasco M del C, Boselli O FG, Blasco C. Carcinoid tumor: about two clinical cases. Journal of Gastroenterology of Peru. 2018; 36(3):269-74.
34. Enciso Zacaria V, Pereira MR, Romero Dure BA, Sung Kim B, Lezcano E, Cantero LR. Gastric carcinoid tumor: a case report from the Clinical Oncology Service of the Instituto de Previsión Social (IPS). Rev public health Parag. 2020; 10(2):67-70.
35. Kato M, Hayashi Y, Fukumoto K, Nagai K, Tsujii Y, Shinzaki S, et al. Early gastric cancer with lymphoid stroma presenting as a subepithelial lesion diagnosed by endoscopic submucosal dissection. Clin J Gastroenterol. 2018; 11(5):382-5.
36. Jacobson BC, Bhatt A, Greer KB, Lee LS, Park WG, Sauer BG, et al. ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions. Am J Gastroenterol. 2023; 118(1):46-58.
37. Ebi M, Nagao K, Sugiyama T, Yamamoto K, Saito T, Kurahashi S, et al. Gastric Plexiform Fibromyxoma Resected Using Nonexposed Endoscopic Wall-Inversion Surgery: A Case Report. Case Rep Gastroenterol. 2022; 16(1):159-64.
38. Igarashi R, Irisawa A, Shibukawa G, Soeta N, Sato A, Yamabe A, et al. Case Report of a Small Gastric Neuroendocrine Tumor in a Deep Layer of Submucosa With Diagnosis by Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Treatment With Laparoscopic and Endoscopic Cooperative Surgery. Clin Med Insights Case Rep. 1 2018;11:117954761774922.
39. Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, et al. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics. 2023; 13(13):2176.
40. Kim SG, Song JH, Hwang JH. Current Status of Endoscopic Ultrasonography in Gastrointestinal Subepithelial Tumors. Clin Endosc. 2019; 52(4):301-5.
41. Manta R, Zito FP, Pugliese F, Caruso A, Mangiafico S, D'Alessandro A, et al. Endoscopic Submucosal Dissection for Subepithelial Tumor Treatment in the Upper Digestive Tract: A Western, Multicenter Study. GE Port J Gastroenterol [Internet]. 2022 [cited 2023 Jul 13];1-6. Available in: https://www.karger.com/Article/FullText/525993
42. Wani S, Keswani RN, Petersen B, Edmundowicz SA, Walsh CM, Huang C, et al. Training in EUS and ERCP: standardizing methods to assess competence. Gastrointestinal Endoscopy. 2018; 87(6):1371-82.
43. Trindade AJ, Benias PC, Alshelleh M, Bazarbashi AN, Tharian B, Inamdar S, et al. Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: a large multicenter study. Endosc Int Open. 2019; 07(07):E931-6.
44. Dumoulin F, Hildenbrand R, Sido B, Sultanie O, Textor J. Subepitheliale Tumoren im Gastrointestinaltrakt – Wie sieht die Praxis aus? Klinikarzt. 2017; 44(09):404-8.
45. Gasmi M, Palazzo L. Tumeurs sous muqueuses digestives. Post'u. 2021; 3(1): 346-350.
46. Villalobos-Garita Á, Téllez-Ávila FI, Ramírez-Luna MÁ. Role of endoscopic ultrasound in the study of subepithelial lesions of the gastrointestinal tract. Endoscopy. 2018; 25(1):35-44.
2. Sekine M, Asano T, Mashima H. The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics [Internet]. 2022; 12(4):810. Available in: https://www.mdpi.com/2075-4418/12/4/810
3. Kim D, Cho S, Park SY, You HS, Jung YW, Cho SH, et al. Natural Course of Asymptomatic Upper Gastrointestinal Subepithelial Lesion of 2 cm or Less in Size. JCM [Internet]. 2022; 11(24):7506. Available in: https://www.mdpi.com/2077-0383/11/24/7506
4. Attila T, Aydin O. Lesion size determines diagnostic yield of EUS-FNA with onsite cytopathologic evaluation for upper gastrointestinal subepithelial lesions. Turk J Gastroenterol. 2018; 29(4):436-41.
5. Mendo R, Barosa R, Pinto Marques P, Albuquerque C, Santos CM. An Unusual Gastric Subepithelial Lesion: Expect the Not so Expectable. GE Port J Gastroenterol [Internet]. 2022 ; 29(1):68-70. Available in: https://www.karger.com/Article/FullText/515467
6. Leal C, Almeida N, Silva M, Santos A, Vasconcelos H, Figueiredo P. Appropriateness of Endoscopic Procedures: A Prospective, Multicenter Study. GE Port J Gastroenterol [Internet]. 2022; 29(1):5-12. Available in: https://www.karger.com/Article/FullText/515839
7. Hu J, Sun X, Ge N, Wang S, Guo J, Liu X, et al. The necessarity of treatment for small gastric subepithelial tumors (1–2 cm) originating from muscularis propria: an analysis of 972 tumors. BMC Gastroenterol. 2022; 22(1):182.
8. Torreblanca-Sierra L, Galvis-García S, Oedroza-Chmorro Y, Orregel-Aguilar V, Zabala-Castillo J. Prevalence of subepithelial lesions evaluated by endoscopic ultrasound in the gastrointestinal endoscopy service of the General Hospital of Mexico "Dr. Eduardo Liceaga". Endoscopy. 2020; 32(Suppl 2):566-72.
9. Ebi M, Nagao K, Sugiyama T, Yamamoto K, Saito T, Kurahashi S, et al. Gastric Plexiform Fibromyxoma Resected Using Nonexposed Endoscopic Wall-Inversion Surgery: A Case Report. Case Rep Gastroenterol [Internet]. 2022 ; 16(1):159-64. Available in: https://www.karger.com/Article/FullText/522411
10. Mosquera-Klinger GA, Carvajal Gutiérrez JJ, Gómez Venegas AA, Niño Ramírez S, Cañadas Garrido R. Endoscopic ultrasound, current applications in gastrointestinal solid tumors. Rev Colomb Gastroenterol. 2020; 35(4):506-18.
11. Fukushi K, Yamamiya A, Tominaga K, Abe Y, Hoshi K, Nagashima K, et al. Usefulness of Adding Maspin Staining to p53 Staining for EUS-FNA Specimens of Pancreatic Ductal Adenocarcinoma. JCM. 2022; 11(20):6097.
12. Chien MM, Lin YH, Chang CC, Chien HY. A Rare Gastric Subepithelial Lesion Removed through Submucosal Tunneling Endoscopic Resection: Case Report and Literature Review. Life [Internet]. 2023; 13(1):179. Available in: https://www.mdpi.com/2075-1729/13/1/179
13. Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, et al. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics. 2023; 13(13):2176.
14. Dorelo R, Taullard A. Prevalence, endoscopic features, and management of subepithelial lesions of the upper gastrointestinal tract. ANFAMED [Internet]. 2020; 7(1). Available in: https://doi.org/10.25184/anfamed2020v7n1a5
15. López-Fuentes J, Flores-Rentería F, Reyes-Aguilar J, Saucedo-Moreno E, Soto-Solís E, Galicia-Gómez T, et al. Diagnostic utility of endoscopic ultrasound in subepithelial lesions of the upper digestive tract. Endoscopy [Internet]. 2020; 32 (Suppl 2). Available at: DOI: 10.24875/END. M20000265
16. Deprez PH, Moons LMG, OʼToole D, Gincul R, Seicean A, Pimentel-Nunes P, et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022; 54(04):412-29.
17. Menon L, Buscaglia JM. Endoscopic approach to subepithelial lesions. Therap Adv Gastroenterol. 2018; 7(3):123-30.
18. Garg R, AlRajjal A, Berri R, Barawi M. Primary Gastric Leiomyosarcoma: a Case Report and Review of the Literature. J Gastrointest Canc. 2020; 51(1):335-40.
19. Lee JC, Curtis D, Williamson JB, Ligato S. Gastric Desmoid Fibromatosis – Report of a Rare Mimic of Gastrointestinal Stromal Tumor. Cureus [Internet]. 2021; Available in: https://www.cureus.com/articles/75847-gastric-desmoid-fibromatosis---report-of-a-rare-mimic-of-gastrointestinal-stromal-tumor
20. Tsai MK, Chen HY, Chuang ML, Chen CW, Jong GP. Gastric Calcifying Fibrous Tumor: An Easy Misdiagnosis as Gastrointestinal Stromal Tumor–A Systemic Review. Medicine. 2020; 56(10):541.
21. Gheorghe G, Bacalbasa N, Ceobanu G, Ilie M, Enache V, Constantinescu G, et al. Gastrointestinal Stromal Tumors—A Mini Review. .JPM. 2021; 11(8):694.
22. Chao L, Torres Y, Barroso L, Cepero M, Cepero-Nogueira N. Value of endoscopic ultrasound in the diagnosis of subepithelial lesions of the gastrointestinal tract. Rev Cub Cir [Internet]. 2018; 7(4). Available in: http://scielo.sld.cu/pdf/cir/v57n4/1561-2945-cir-57-04-e760.pdf
23. Yamamoto K, Ikeya T, Kanomata N, Deshpande GA, Takagi K, Omata F. Three Types of Subepithelial Lesion-Like Gastric Cancer Including a New Entity of Gastric Adenocarcinoma. Case Rep Gastroenterol [Internet]. 2022; 16(2):368-74. Available in: https://www.karger.com/Article/FullText/524792
24. Deprez PH, Moons LMG, OʼToole D, Gincul R, Seicean A, Pimentel-Nunes P, et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022; 54(04):412-29.
25. De Moura DTH, McCarty TR, Jirapinyo P, Ribeiro IB, Flumignan VK, Najdawai F, et al. EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: a large multicenter study. Gastrointestinal Endoscopy. 2020; 92(1):108-119.e3.
26. Chen G, Nie L, Zhang T. An extremely rare case of a gastric accessory spleen: case report and review of the literature. BMC Gastroenterol. 2021; 21(1):275.
27. Moreno-Paquentín E, Molina DC, Sánchez-García J, Arrangoiz-Majul R. Clinical case report of a giant gastrointestinal stromal tumor (GIST) and literature review. Surgeon General.
28. Zhong Z, Xu Y, Liu J, Zhang C, Xiao Z, Xia Y, et al. Clinicopathological study of gastric schwannoma and review of related literature. BMC Surg. 2022; 22(1):159.
29. Gastrointestinal stromal tumors in a hospital in Mexico | Moreno Galeana - España | Revista Cubana de Cirugía [Internet]. Available in: https://revcirugia.sld.cu/index.php/cir/article/view/1127/666
30. Advancements in the Diagnosis of Gastric Subepithelial Tumors [Internet]. Available in: https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl210242
31. Rodríguez-Infante A, Fernández-Martínez D, García-Iglesias E, Rodríguez-Infante A, Fernández-Martínez D, García-Iglesias E. Ectopic pancreas: a very rare intestinal mass. Spanish Journal of Digestive Diseases. 2018; 110(2):127-8.
32. Salceda-Otero JC, Duarte JE, Sabbagh L. Gastric ectopic pancreas of infrequent localization in the muscularis of the mucosa. Rev Gastroenterol Mex. 2018; 76(1):73-8.
33. Blasco M del C, Boselli O FG, Blasco C. Carcinoid tumor: about two clinical cases. Journal of Gastroenterology of Peru. 2018; 36(3):269-74.
34. Enciso Zacaria V, Pereira MR, Romero Dure BA, Sung Kim B, Lezcano E, Cantero LR. Gastric carcinoid tumor: a case report from the Clinical Oncology Service of the Instituto de Previsión Social (IPS). Rev public health Parag. 2020; 10(2):67-70.
35. Kato M, Hayashi Y, Fukumoto K, Nagai K, Tsujii Y, Shinzaki S, et al. Early gastric cancer with lymphoid stroma presenting as a subepithelial lesion diagnosed by endoscopic submucosal dissection. Clin J Gastroenterol. 2018; 11(5):382-5.
36. Jacobson BC, Bhatt A, Greer KB, Lee LS, Park WG, Sauer BG, et al. ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions. Am J Gastroenterol. 2023; 118(1):46-58.
37. Ebi M, Nagao K, Sugiyama T, Yamamoto K, Saito T, Kurahashi S, et al. Gastric Plexiform Fibromyxoma Resected Using Nonexposed Endoscopic Wall-Inversion Surgery: A Case Report. Case Rep Gastroenterol. 2022; 16(1):159-64.
38. Igarashi R, Irisawa A, Shibukawa G, Soeta N, Sato A, Yamabe A, et al. Case Report of a Small Gastric Neuroendocrine Tumor in a Deep Layer of Submucosa With Diagnosis by Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Treatment With Laparoscopic and Endoscopic Cooperative Surgery. Clin Med Insights Case Rep. 1 2018;11:117954761774922.
39. Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, et al. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics. 2023; 13(13):2176.
40. Kim SG, Song JH, Hwang JH. Current Status of Endoscopic Ultrasonography in Gastrointestinal Subepithelial Tumors. Clin Endosc. 2019; 52(4):301-5.
41. Manta R, Zito FP, Pugliese F, Caruso A, Mangiafico S, D'Alessandro A, et al. Endoscopic Submucosal Dissection for Subepithelial Tumor Treatment in the Upper Digestive Tract: A Western, Multicenter Study. GE Port J Gastroenterol [Internet]. 2022 [cited 2023 Jul 13];1-6. Available in: https://www.karger.com/Article/FullText/525993
42. Wani S, Keswani RN, Petersen B, Edmundowicz SA, Walsh CM, Huang C, et al. Training in EUS and ERCP: standardizing methods to assess competence. Gastrointestinal Endoscopy. 2018; 87(6):1371-82.
43. Trindade AJ, Benias PC, Alshelleh M, Bazarbashi AN, Tharian B, Inamdar S, et al. Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: a large multicenter study. Endosc Int Open. 2019; 07(07):E931-6.
44. Dumoulin F, Hildenbrand R, Sido B, Sultanie O, Textor J. Subepitheliale Tumoren im Gastrointestinaltrakt – Wie sieht die Praxis aus? Klinikarzt. 2017; 44(09):404-8.
45. Gasmi M, Palazzo L. Tumeurs sous muqueuses digestives. Post'u. 2021; 3(1): 346-350.
46. Villalobos-Garita Á, Téllez-Ávila FI, Ramírez-Luna MÁ. Role of endoscopic ultrasound in the study of subepithelial lesions of the gastrointestinal tract. Endoscopy. 2018; 25(1):35-44.
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Published
Nov 10, 2023
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Andrea Carolina Gómez Molina, & Manuel Rafael Aldás Erazo. (2023). ENDOSCOPIC MANAGEMENT OF SUBEPITHELIAL LESIONS OF THE STOMACH. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 1874–1885. https://doi.org/10.53555/jptcp.v30i18.3372
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Author Biographies
Andrea Carolina Gómez Molina
Estudiante de la carrera de Medicina de la Universidad Católica de Cuenca
Manuel Rafael Aldás Erazo
Docente Universidad Católica de Cuenca