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Koizumi E, Goto O, Matsuda A, Otsuka T, Ishikawa Y, Nakagome S, Niikawa M, Habu T, Yoshikata K, Kirita K, Noda H, Higuchi K, Onda T, Omori J, Akimoto N, Yoshida H, Iwakiri K. Diagnostic ability and adverse events of mucosal incision-assisted biopsy for gastric subepithelial tumors: Systematic review and meta-analysis. Dig Endosc 2024. [PMID: 39370533 DOI: 10.1111/den.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/02/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to evaluate the diagnostic ability and examine the efficacy of countermeasures to adverse events of mucosal incision-assisted biopsy (MIAB) for gastric subepithelial tumors (SETs). METHODS We performed a literature search and identified 533 relevant articles. Eleven articles, including 339 lesions, were ultimately used in the meta-analysis. The primary end-point was the pathological diagnostic rate of MIAB for gastric SETs, and the secondary end-point was the incidence of adverse events. The efficacy of acid secretion inhibitors in preventing postoperative bleeding and that of local injection before incision to prevent perforation were also examined. RESULTS Nine studies were conducted in Japan and two in South Korea, of which only two were prospective studies. The pooled pathological diagnostic rate of MIAB for gastric SETs was 87.8% (95% confidence interval [CI] 80.2-94.0; I2 = 68.7%). The adverse event rate of the pooled population was 0.2% (95% CI 0-1.4; I2 = 0%). The acid secretion inhibitors significantly reduced postoperative bleeding (odds ratio 0.06, 95% CI 0.01-0.66, P = 0.02). Perforation occurred in 0% and 2.6% of the local and nonlocal injection cohorts, respectively, and the pathological diagnostic rates were 50% and 66.7%, respectively. CONCLUSIONS MIAB is a reliable technique with a favorable diagnostic rate and few adverse events. Acid secretion inhibitors may effectively prevent postoperative bleeding; however, the efficacy of local injection remains unclear. This technique could be an option for tissue sampling in gastric SETs.
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Affiliation(s)
- Eriko Koizumi
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Osamu Goto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Endoscopy Center, Nippon Medical School Hospital, Tokyo, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Yumiko Ishikawa
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Shun Nakagome
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Masahiro Niikawa
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Tsugumi Habu
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Keiichiro Yoshikata
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Kumiko Kirita
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Hiroto Noda
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Kazutoshi Higuchi
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Onda
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Naohiko Akimoto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
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Min L, Jin Y, Chen J, Zhu H, Liang C, Lv L, Wang Y, Liu D, Zhou Y, Chu Y, Tan Y. Endoscopic ultrasound-guided bite-on-bite biopsy and endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of gastric tumors with negative malignant endoscopy biopsies: a retrospective cohort study. MINIM INVASIV THER 2024:1-11. [PMID: 39046283 DOI: 10.1080/13645706.2024.2381103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/09/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Specific types of gastric tumors, including gastric linitis plastica and lymphoma, may cause extensive deep-layer infiltration, impeding an accurate diagnosis with endoscopic biopsy. This study aims to evaluate the efficacy of endoscopic ultrasound (EUS)-guided bite-on-bite biopsy and EUS-guided fine-needle aspiration (EUS-FNA) in diagnosing gastric malignancies with negative endoscopic biopsies. METHODS We retrospectively analyzed suspicious malignant gastric lesion cases in our hospital from October 2017 to August 2023. Clinical manifestations, radiographical examinations, endoscopic examinations, histopathological results, and therapeutic strategies were recorded and analyzed. RESULTS Forty malignant gastric tumor cases with negative endoscopic biopsies were incorporated into our study. EUS-guided bite-on-bite biopsy was performed in 16 cases exclusively, whereas 17 patients received EUS-FNA exclusively, and seven patients underwent both simultaneously. Among the 23 patients who received the EUS-guided bite-on-bite biopsy, 22 (95.7%) were diagnosed with malignancies. Among the 24 patients who received EUS-FNA, a total of 19 cases with malignancies (79.2%) were confirmed by EUS-FNA (p = 0.11): 13 gastric adenocarcinomas, five metastatic malignancies, and one malignant stromal tumor. No adverse events were observed in any of the cases. CONCLUSIONS EUS-guided bite-on-bite biopsy and EUS-FNA possess their advantages and disadvantages. EUS-guided bite-on-bite biopsy could serve as a reliable diagnostic method for shallow lesions with negative malignant endoscopic biopsies.
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Affiliation(s)
- Liang Min
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yan Jin
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Jiefei Chen
- Department of Laboratory Medicine, Xiangya School of Medicine, Central South University, Changsha, China
| | - Hongyi Zhu
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Chengbai Liang
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Liang Lv
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yongjun Wang
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Deliang Liu
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yuqian Zhou
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yi Chu
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yuyong Tan
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
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Verloop C, Hol L, Bruno M, Van Driel L, Koch AD. Endoscopic resection in subepithelial lesions of the upper gastrointestinal tract: Experience at a tertiary referral hospital in The Netherlands. Endosc Int Open 2024; 12:E868-E874. [PMID: 38989251 PMCID: PMC11236476 DOI: 10.1055/a-2325-3747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/03/2024] [Indexed: 07/12/2024] Open
Abstract
Background and study aims Histological confirmation of subepithelial lesions (SELs) in the upper gastrointestinal tract remains challenging. Endoscopic resection of SELs is increasingly used for its excellent diagnostic yield and opportunity to do away with continued surveillance. In this study, we aimed to evaluate the indications, success rates and complications of different endoscopic resection techniques for SELs at a large, tertiary referral hospital in Rotterdam, The Netherlands. Patients and methods Data between October 2013 and December 2021 were retrospectively collected and analyzed. Main outcomes were R0-resection rate, en bloc resection rate, recurrence rate, and procedure-related adverse events (AEs) (Clavien-Dindo). Secondary outcomes were procedure time, need for surgical intervention, and clinical impact on patient management. Results A total of 58 patients were referred for endoscopic resection of upper gastrointestinal SELs. The median diameter of lesions was 20 mm (range 7-100 mm). Median follow-up time was 5 months (range 0.4-75.7). Forty-eight procedures (83%) were completed successfully leading to en bloc resection in 85% and R0-resection in 63%. Procedure-related AEs occurred in six patients (13%). Severe complications (CD grade 3a) were seen in three patients. The local recurrence rate for (pre)malignant diagnosis was 2%. Additional surgical intervention was needed in seven patients (15%). A total of 32 patients (67%) could be discharged from further surveillance after endoscopic resection. Conclusions Endoscopic resection is a safe and effective treatment for SELs and offers valuable information about undetermined SELs for which repeated sampling attempts have failed to provide adequate tissue for diagnosis.
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Affiliation(s)
- Cynthia Verloop
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
| | - Lieke Hol
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Lydi Van Driel
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Arjun Dave Koch
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
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4
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Verloop CA, Goos JAC, Bruno MJ, Quispel R, van Driel LMJW, Hol L. Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review. Gastrointest Endosc 2024; 99:895-911.e13. [PMID: 38360118 DOI: 10.1016/j.gie.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND AIMS Obtaining adequate tissue samples in subepithelial lesions (SELs) remains challenging. Several biopsy techniques are available, but a systematic review including all available techniques to obtain a histologic diagnosis of SEL is lacking. The aim of this study was to evaluate the diagnostic yield and adverse event rates of endoscopic biopsies, EUS-guided FNA (EUS-FNA), EUS-guided fine-needle biopsy (FNB) (EUS-FNB), and mucosal incision-assisted biopsy (MIAB) for SELs in the upper GI tract. METHODS A search strategy in multiple databases was performed. The primary outcome was diagnostic yield, defined as the percentage of procedures in which histology was obtained and resulted in a definitive histopathologic diagnosis. Secondary outcome measures included reported procedure-related adverse events, which were graded according to the AGREE (Adverse Events in Gastrointestinal Endoscopy) classification. RESULTS A total of 94 original articles were included. Studies were classified per endoscopic technique to obtain histopathology. This resulted in 8 included studies for endoscopic biopsy methods, 55 studies for EUS-FNA, 33 studies for EUS-FNB, and 26 studies for MIAB. Pooled rates for diagnostic yield were 40.6% (95% confidence interval [CI], 30.8-51.2) for endoscopic biopsy, 74.6% (95% CI, 69.9-78.7) for EUS-FNA, 84.2% (95% CI, 80.7-87.2) for EUS-FNB, and 88.2% (95% CI, 84.7-91.1) for MIAB. Reported procedure-related adverse events graded AGREE II or higher were 2.8% to 3.9% for endoscopic biopsies, 1.0% to 4.5% for EUS-FNA, .9% to 7.7% for EUS-FNB, and 1.9% to 7.9% for MIAB. CONCLUSIONS Based on the available evidence, MIAB and EUS-FNB seem to be most effective in terms of achieving a high diagnostic yield, with similar rates of adverse events.
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Affiliation(s)
- Cynthia A Verloop
- Department of Gastroenterology, Maasstad Hospital, Rotterdam, the Netherlands.
| | - Jacqueline A C Goos
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology, Erasmus University Medical Centre, Rotterdam the Netherlands
| | - Rutger Quispel
- Department of Gastroenterology, Reinier de Graaf hospital, Delft, the Netherlands
| | - Lydi M J W van Driel
- Department of Gastroenterology, Erasmus University Medical Centre, Rotterdam the Netherlands
| | - Lieke Hol
- Department of Gastroenterology, Maasstad Hospital, Rotterdam, the Netherlands
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Cai M, Song B, Deng Y, Gao P, Cai S, Yalikong A, Xu E, Zhong Y, Yu J, Zhou P. Automatically optimized radiomics modeling system for small gastric submucosal tumor (<2 cm) discrimination based on EUS images. Gastrointest Endosc 2024; 99:537-547.e4. [PMID: 37956896 DOI: 10.1016/j.gie.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND AIMS The clinical management of small gastric submucosal tumors (SMTs) (<2 cm) faces a non-negligible challenge because of the lack of guideline consensus and effective diagnostic tools. This article develops an automatically optimized radiomics modeling system (AORMS) based on EUS images to diagnose and evaluate SMTs. METHODS A total of 205 patients with EUS images of small gastric SMTs (<2 cm) were retrospectively enrolled in the development phase of AORMS for the diagnosis and the risk stratification of GI stromal tumor (GIST). A total of 178 patients with images from different centers were prospectively enrolled in the independent testing phase. The performance of AORMS was compared to that of endoscopists in the development set and evaluated in the independent testing set. RESULTS AORMS demonstrated an area under the curve (AUC) of 0.762 for the diagnosis of GIST and 0.734 for the risk stratification of GIST, respectively. In the independent testing set, AORMS achieved an AUC of 0.770 and 0.750 for the diagnosis and risk stratification of small GISTs, respectively. In comparison, the AUCs of 5 experienced endoscopists ranged from 0.501 to 0.608 for diagnosing GIST and from 0.562 to 0.748 for risk stratification. AORMS outperformed experienced endoscopists by more than 20% in diagnosing GIST. CONCLUSIONS AORMS implements automatic parameter selection, which enhances its robustness and clinical applicability. It has demonstrated good performance in the diagnosis and risk stratification of GISTs, which could aid endoscopists in the diagnosis of small gastric SMTs (<2 cm).
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Affiliation(s)
- Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Baohui Song
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Yinhui Deng
- MingGe Research, Fudan University Science Park, Shanghai, China; Biomedical Engineering Center, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Pingting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Shilun Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Ayimukedisi Yalikong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Enpan Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Yunshi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China; Department of Endoscopy, Zhongshan Hospital Xuhui Branch, Fudan University, Shanghai, China.
| | - Jinhua Yu
- Biomedical Engineering Center, School of Information Science and Technology, Fudan University, Shanghai, China.
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China.
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Hikichi T, Hashimoto M, Yanagita T, Kato T, Nakamura J. Endoscopic ultrasound-guided fine-needle aspiration for gastrointestinal subepithelial lesions. J Med Ultrason (2001) 2024; 51:195-207. [PMID: 37490244 DOI: 10.1007/s10396-023-01342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/26/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the first-choice procedure for obtaining pathological tissue samples from gastrointestinal (GI) subepithelial lesions (SELs). However, its diagnostic accuracy is lower than that for pancreatic masses owing to puncture difficulty and the need for immunostaining for definitive diagnosis. The advent of fine-needle biopsy needles, which have become well known in recent years, improves the diagnostic accuracy of EUS-FNA for GI SELs. The forward-viewing echoendoscope and rapid on-site evaluation (ROSE) have also helped to improve diagnostic accuracy. Furthermore, in facilities where ROSE is not available, endosonographers perform a macroscopic on-site evaluation. With these procedural innovations, EUS-FNA is now performed aggressively even for SELs smaller than 20 mm. The incidence of procedure-related adverse events such as bleeding and infection is low, and thus, EUS-FNA can be safely performed to diagnose SELs.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takumi Yanagita
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Kawai T, Inoue H, Yao K, Kaise M, Kato M, Tanabe S, Sakata Y. Advanced diagnostic endoscopy in the upper gastrointestinal tract: Review of the Japan Gastroenterological Endoscopy Society core sessions. Dig Endosc 2023; 35:711-717. [PMID: 37183343 DOI: 10.1111/den.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/12/2023] [Indexed: 05/16/2023]
Abstract
We held four upper gastrointestinal tract advanced diagnostic endoscopy sessions from the 89th to the 92nd Congress of the Japan Gastroenterological Endoscopy Society. The most common region addressed was the stomach in 25 presentations, followed by the esophagus in 23, duodenum in five, and other in one. Looking at techniques discussed, the most common image enhancement method discussed was narrowband imaging in 29 presentations, blue laser imaging, and linked color imaging (LCI) in 10 each, dual red imaging in three, and autofluorescence imaging in one. Furthermore, there were presentations of new techniques such as M-Chromo-LCI and acetic acid-indigo carmine mixture LCI. There were also six presentations regarding probe-based confocal laser endomicroscopy, and one of endocytoscopy techniques. We also saw presentations of images of gastric subepithelial tumors within the submucosa, 3D endoscopy, the development of computer-aided detection systems for early cancers, and fluorescent imaging.
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Affiliation(s)
- Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology and Hepatology, Nihon Medical University, Tokyo, Japan
| | | | - Satoshi Tanabe
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasuhisa Sakata
- Department of Internal Medicine and Gastroenterology, Saga Medical School, Saga, Japan
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ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions. Am J Gastroenterol 2023; 118:46-58. [PMID: 36602835 DOI: 10.14309/ajg.0000000000002100] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/29/2022] [Indexed: 01/06/2023]
Abstract
Subepithelial lesions (SEL) of the GI tract represent a mix of benign and potentially malignant entities including tumors, cysts, or extraluminal structures causing extrinsic compression of the gastrointestinal wall. SEL can occur anywhere along the GI tract and are frequently incidental findings encountered during endoscopy or cross-sectional imaging. This clinical guideline of the American College of Gastroenterology was developed using the Grading of Recommendations Assessment, Development, and Evaluation process and is intended to suggest preferable approaches to a typical patient with a SEL based on the currently available published literature. Among the recommendations, we suggest endoscopic ultrasound (EUS) with tissue acquisition to improve diagnostic accuracy in the identification of solid nonlipomatous SEL and EUS fine-needle biopsy alone or EUS fine-needle aspiration with rapid on-site evaluation sampling of solid SEL. There is insufficient evidence to recommend surveillance vs resection of gastric gastrointestinal stromal tumors (GIST) <2 cm in size. Owing to their malignant potential, we suggest resection of gastric GIST >2 cm and all nongastric GIST. When exercising clinical judgment, particularly when statements are conditional suggestions and/or treatments pose significant risks, health-care providers should incorporate this guideline with patient-specific preferences, medical comorbidities, and overall health status to arrive at a patient-centered approach.
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Maehata T, Sato Y, Nakamoto Y, Kato M, Kawashima A, Kiyokawa H, Yasuda H, Yamamoto H, Tateishi K. Updates in the Field of Submucosal Endoscopy. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010104. [PMID: 36676053 PMCID: PMC9864725 DOI: 10.3390/life13010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
Submucosal endoscopy (third-space endoscopy) can be defined as an endoscopic procedure performed in the submucosal space. This procedure is novel and has been utilized for delivery to the submucosal space in a variety of gastrointestinal diseases, such as a tumor, achalasia, gastroparesis, and subepithelial tumors. The main submucosal endoscopy includes peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, and endoscopic submucosal tunnel dissection. Submucosal endoscopy has been used as a viable alternative to surgical techniques because it is minimally invasive in the treatment and diagnosis of gastrointestinal diseases and disorders. However, there is limited evidence to prove this. This article reviews the current applications and evidence regarding submucosal endoscopy while exploring the possible future clinical applications in this field. As our understanding of these procedures improves, the future of submucosal endoscopy could be promising in the fields of diagnostic and therapeutic endoscopy.
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10
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Kanesaka T, Inoue T, Tajiri A, Fukuda H, Waki K, Shichijo S, Maekawa A, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Michida T, Tanada S, Honma K, Ishihara R. Boring biopsy with rapid on-site evaluation for gastric gastrointestinal stromal tumor: A pilot study. JGH Open 2022; 7:68-71. [PMID: 36660046 PMCID: PMC9840186 DOI: 10.1002/jgh3.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022]
Abstract
One of 4 patients (25%) and 2 of 3 patients (67%) were correctly diagnosed by conventional and hot boring biopsies, respectively. The median procedure time of conventional and hot boring biopsies was 21 (range, 13-33) and 17 (range, 16-23) min, respectively. Rapid on-site evaluation was performed totally 12 times in 7 patients. The positive and negative predictive values of rapid on-site evaluation for gastrointestinal stromal tumor were 0.5 (0.12-0.88) and 1.0 (0.42-1.00), respectively.
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Affiliation(s)
- Takashi Kanesaka
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan,Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineSuitaJapan
| | - Takahiro Inoue
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Ayaka Tajiri
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan,Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineSuitaJapan
| | - Hiromu Fukuda
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan,Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineSuitaJapan
| | - Kotaro Waki
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Satoki Shichijo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Akira Maekawa
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Sachiko Yamamoto
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yoji Takeuchi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Koji Higashino
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Noriya Uedo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Tomoki Michida
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Satoshi Tanada
- Department of Diagnostic Pathology and CytologyOsaka International Cancer InstituteOsakaJapan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and CytologyOsaka International Cancer InstituteOsakaJapan
| | - Ryu Ishihara
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
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11
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Giri S, Afzalpurkar S, Angadi S, Sundaram S. Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis. Clin Endosc 2022; 55:615-625. [PMID: 36205045 PMCID: PMC9539302 DOI: 10.5946/ce.2022.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background/Aims Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.
Methods A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
Results Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events.
Conclusions MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.
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Affiliation(s)
| | - Shivaraj Afzalpurkar
- Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, India
| | | | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
- Correspondence: Sridhar Sundaram Department of Digestive Disease and Clinical Nutrition, TATA Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai 400012, India E-mail:
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12
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The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics (Basel) 2022; 12:diagnostics12040810. [PMID: 35453857 PMCID: PMC9027519 DOI: 10.3390/diagnostics12040810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period.
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13
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Hashimoto C, Hikichi T, Hashimoto M, Waragai Y, Takasumi M, Nakamura J, Kato T, Kobashi R, Takagi T, Suzuki R, Sugimoto M, Sato Y, Irie H, Okubo Y, Satake S, Kobayakawa M, Hashimoto Y, Ohira H. Localized gastric amyloidosis diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:1036-1041. [PMID: 33886105 DOI: 10.1007/s12328-021-01416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
A 49-year-old man was found to have an elevated lesion on esophagogastroduodenoscopy (EGD) for gastric cancer screening. This lesion had been noted in EGD 13 years earlier, but the patient had not received EGD since then. Endoscopy showed a relatively soft subepithelial lesion (SEL) in the gastric antrum. In addition, endoscopic ultrasonography (EUS) showed a 20-mm-sized, slightly non-uniform hypoechoic mass in the submucosa. Since the diagnosis could not be confirmed by mucosal biopsy, EUS-guided fine-needle aspiration (EUS-FNA) was performed. Hematoxylin-eosin staining of EUS-FNA samples revealed deposition of acidophilic unstructured materials. The structure was positive on Congo red staining, and green polarized light was also observed under a polarizing microscope. Moreover, it was resistant to potassium permanganate reaction, negative for serum amyloid A protein, positive for anti-λ chain antibody, and negative for anti-κ chain, anti-amyloid A, anti-transthyretin, and anti-β2-microglobulin antibodies. Therefore, the lesion was diagnosed as AL-λ-type amyloidosis. No systemic amyloidosis findings were found; thus, the patient was finally diagnosed with localized gastric AL amyloidosis. If an SEL is seen without disease-specific endoscopic findings, amyloidosis should be included in the differential diagnosis, and EUS-FNA can contribute to obtaining tissue samples in such cases.
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Affiliation(s)
- Choichiro Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
| | - Minami Hashimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yuichi Waragai
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Mika Takasumi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshinori Okubo
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shunsuke Satake
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Medical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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14
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Sekine M, Miura T, Fujiwara J, Uehara T, Asano T, Matsumoto S, Miyatani H, Mashima H. Utility of endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) for diagnosing small subepithelial lesions (< 20 mm). J Ultrasound 2021; 25:35-40. [PMID: 33511507 PMCID: PMC8964910 DOI: 10.1007/s40477-020-00548-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/04/2020] [Indexed: 11/03/2022] Open
Abstract
AIM Subepithelial lesions (SELs) are defined as being located under the mucosa. Presently, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is commonly performed to diagnose SELs. With the development of new puncture needles, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB), which allows for the acquisition of large tissue samples, has been proposed. However, studies on EUS-FNB of SELs measuring < 20 mm have not yielded satisfactory results. Therefore, we aimed to assess the performance and usefulness of EUS-FNB of SELs measuring less than < 20 mm. METHODS The present study included 62 patients who underwent EUS-FNA or EUS-FNB for SELs at our hospital between January 2015 and March 2019. EUS-FNA was performed using fine-needle aspiration needles, and EUS-FNB was performed using fine-needle biopsy needles. These needles, which come in different shapes and diameters, were compared in terms of their usefulness in performing procedures for SELs measuring ≥ 20 mm and those measuring < 20 mm. RESULTS For SELs measuring ≥ 20 mm, the use of needles with a large diameter, such as 19 or 20 G, resulted in significantly improved diagnostic rates. For SELs measuring < 20 mm, the use of FNB needles showed significantly improved diagnostic rates, regardless of the size of the puncture needles. CONCLUSION Even when SELs are less than 20 mm, they might have malignant potential, and histological diagnosis may be desirable in some cases. EUS-FNB has an advantage over EUS-FNA in the diagnosis of SELs measuring < 20 mm.
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Affiliation(s)
- Masanari Sekine
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan.
| | - Takaya Miura
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Junichi Fujiwara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Takeharu Asano
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Hiroyuki Miyatani
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
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15
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Turner RBS, Liffman R, Woodward AP, Beck C, Courtman N, Dandrieux JRS. Assessment of the clinical usefulness of ultrasound-guided cytological specimens obtained from gastrointestinal lesions in dogs and cats. J Small Anim Pract 2021; 62:114-122. [PMID: 33403667 DOI: 10.1111/jsap.13260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cytological biopsies are an integral additional test to an abdominal ultrasound when a lesion is identified, but there is little published on factors that that may impact achieving a clinically useful sample of gastrointestinal lesions obtained by ultrasound-guided fine-needle cytologic biopsy. This retrospective, descriptive study aimed to assess factors that may influence the clinical usefulness of submitted cytological samples collected from gastrointestinal lesions by ultrasound-guided percutaneous fine-needle cytologic biopsy. MATERIAL AND METHODS Gastrointestinal cytological samples obtained from 25 dogs and 19 cats over 2.5 years were reviewed and determined as clinically useful or clinically useless as per the cytology report. Variables dependent on the ultrasound exam that were used in the analysis included lesion location, lesion thickness, loss of gastrointestinal layering, and the number of slides submitted. RESULTS Thirty (30/44) of the submitted cytological samples were considered clinically useful. Factors associated with achieving a clinically useful sample in univariable models included the number of slides submitted and the thickness of the lesion. However, these two variables appear inter-related, as a weak correlation existed between them. Where histologic biopsies were obtained, a clinically useful sample had a partial or complete agreement with histology in three of 12 and eight of 12 cases, respectively. CLINICAL SIGNIFICANCE Ultrasound-guided fine-needle cytological biopsies of gastrointestinal masses provided a clinically useful sample in two-third of the cases, especially if more slides were provided to the cytologist and thicker lesions were sampled.
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Affiliation(s)
- R B S Turner
- U-Vet Animal Hospital, University of Melbourne, Werribee, VIC, 3030, Australia
| | - R Liffman
- U-Vet Animal Hospital, University of Melbourne, Werribee, VIC, 3030, Australia
| | - A P Woodward
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, VIC, 3030, Australia
| | - C Beck
- U-Vet Animal Hospital, University of Melbourne, Werribee, VIC, 3030, Australia
| | - N Courtman
- U-Vet Animal Hospital, University of Melbourne, Werribee, VIC, 3030, Australia
| | - J R S Dandrieux
- U-Vet Animal Hospital, University of Melbourne, Werribee, VIC, 3030, Australia
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16
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Simplified Submucosal Tunneling Biopsy Using Clip-With-Line Traction and Closure for Gastric Subepithelial Lesion. Diagnostics (Basel) 2020; 10:diagnostics10090690. [PMID: 32932714 PMCID: PMC7556007 DOI: 10.3390/diagnostics10090690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has emerged as a standard and convenient method for the sampling of subepithelial lesions (SELs). Immunohistological analysis is required to definitively distinguish mesenchymal tumors; however, EUS-FNA provides insufficient material to achieve this, especially for small SELs < 2 cm. We therefore previously reported a novel submucosal tunneling biopsy (STB) technique that utilizes endoscopic submucosal dissection (ESD) for sampling SELs. However, unresolved advanced technical issues have hindered its widespread application. Currently, a counter-traction technique is used to facilitate ESD. We here describe a technically simplified STB technique using clip-with-line traction for gastric SELs.
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17
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Dhaliwal A, Kolli S, Dhindsa BS, Mashiana HS, Bhogal N, Bhat I, Singh S, Adler DG. Diagnostic yield of deep biopsy via endoscopic submucosal dissection for the diagnosis of upper gastrointestinal subepithelial tumors: a systematic review and meta-analysis. Ann Gastroenterol 2020; 33:30-37. [PMID: 31892795 PMCID: PMC6928476 DOI: 10.20524/aog.2019.0444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Conventionally, endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNA)/EUS-FNB) has been used for tissue diagnosis of upper gastrointestinal (GI) subepithelial tumors (SETs). However, deep biopsy (DB) via endoscopic submucosal dissection (ESD) is emerging as an alternative technique, given the inadequate tissue sampling with EUS-FNA/EUS-FNB. Our aim was to conduct a systematic review and meta-analysis to report the overall diagnostic yield of DB via ESD for upper GI SETs. Methods: PubMed, Cochrane Library and Web of Science databases were searched to identify studies (from commencement to Oct 2017) that reported the DB via ESD technique for diagnosis of upper GI SETs. The primary outcome of interest was the method’s overall diagnostic yield and the secondary outcome was to the occurrence of complications. The meta-analysis was performed using the DerSimonian and Laird random-effects model. Results: A total of 7 studies, comprising 209 patients with a mean age of 57.3 years, were included in the final meta-analysis. The overall pooled diagnostic yield of DB via ESD for upper GI SETs was 95% (95% confidence interval [CI] 84.91-99.98, I2=78.2%). Overall, pooled outcomes of major bleeding and perforation in our meta-analysis was noted in 0.07% (95%CI 0.00-2.32, I2=0%) and 0% (95%CI 0.00-1.70, I2=0%) respectively. Data regarding major bleeding and perforation rates were not reported in 2 studies. Substantial heterogeneity was observed in our meta-analysis. Conclusion: DB via ESD is an effective and safe procedure for diagnosing upper GI SETs. Further multicenter randomized controlled trials are needed to validate these findings.
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Affiliation(s)
- Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha (Amaninder Dhaliwal, Singh Mashiana, Neil Bhogal, Ishfaq Bhat, Shailender Singh)
| | - Sindhura Kolli
- Department of Internal Medicine, The Brooklyn Hospital Center, New York (Sindhura Kolli)
| | - Banreet Singh Dhindsa
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine (Banreet Singh Dhindsa)
| | - Harmeet Singh Mashiana
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha (Amaninder Dhaliwal, Singh Mashiana, Neil Bhogal, Ishfaq Bhat, Shailender Singh)
| | - Neil Bhogal
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha (Amaninder Dhaliwal, Singh Mashiana, Neil Bhogal, Ishfaq Bhat, Shailender Singh)
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha (Amaninder Dhaliwal, Singh Mashiana, Neil Bhogal, Ishfaq Bhat, Shailender Singh)
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha (Amaninder Dhaliwal, Singh Mashiana, Neil Bhogal, Ishfaq Bhat, Shailender Singh)
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Douglas G. Adler), USA
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18
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Tanabe H, Ando K, Sutoh D, Ohta K, Ohdaira H, Suzuki Y, Fujiya M, Okumura T. A case of gastric carcinoma with lymphoid stroma diagnosed by an endoscopic ultrasound-guided fine-needle biopsy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:419-422. [PMID: 30746709 DOI: 10.1002/jcu.22696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
Endoscopic ultrasound-guided sampling is indicated to achieve an accurate diagnosis of subepithelial lesions of the stomach when a standard biopsy fails. Gastric carcinoma with lymphoid stroma (GCLS) is located under the epithelial layer with dense lymphocytic infiltration, making a pathological diagnosis by a biopsy difficult. We herein report a case of the pathological diagnosis of GCLS using an endoscopic ultrasound-guided fine-needle biopsy. The patient underwent distal gastrectomy and was diagnosed with Epstein-Barr virus-negative cancer.
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Affiliation(s)
- Hiroki Tanabe
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
- Division of Gastroenterology and Hematology/Oncology Department of medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Katsuyoshi Ando
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
- Division of Gastroenterology and Hematology/Oncology Department of medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Daisuke Sutoh
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Katsuhisa Ohta
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology Department of medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology Department of medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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19
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Osoegawa T, Minoda Y, Ihara E, Komori K, Aso A, Goto A, Itaba S, Ogino H, Nakamura K, Harada N, Makihara K, Tsuruta S, Yamamoto H, Ogawa Y. Mucosal incision-assisted biopsy versus endoscopic ultrasound-guided fine-needle aspiration with a rapid on-site evaluation for gastric subepithelial lesions: A randomized cross-over study. Dig Endosc 2019; 31:413-421. [PMID: 30723945 DOI: 10.1111/den.13367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to compare the diagnostic yield of mucosal incision-assisted biopsy (MIAB) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a rapid on-site evaluation (ROSE) for gastric subepithelial lesions (SEL) suspected of being gastrointestinal stromal tumors (GIST) with an intraluminal growth pattern. METHODS This was a prospective randomized, cross-over multicenter study. The primary outcome was the diagnostic yield of EUS-FNA and MIAB. The secondary outcomes were the technical success rate, complication rate, procedure time and biopsy frequency. RESULTS A total of 47 patients were randomized to the MIAB group (n = 23) and EUS-FNA group (n = 24). There was no significant difference in the diagnostic yield of MIAB and EUS-FNA (91.3% vs 70.8%, P = 0.0746). The complication rates of MIAB and EUS-FNA did not differ to a statistically significant extent. The mean procedure time in the MIAB group was significantly longer than that in the EUS-FNA group (34 vs 26 min, P = 0.0011). CONCLUSIONS The diagnostic yield of MIAB was satisfactorily as high as EUS-FNA with ROSE for gastric SEL with an intraluminal growth pattern.
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Affiliation(s)
- Takashi Osoegawa
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keishi Komori
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Aso
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayako Goto
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Soichi Itaba
- Department of Gastroenterology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Nakamura
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naohiko Harada
- Department of Gastroenterology, Kyushu Medical Center, Fukuoka, Japan
| | - Kosuke Makihara
- Department of Anatomic Pathology, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Shinichi Tsuruta
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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20
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Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol 2018; 24:2806-2817. [PMID: 30018476 PMCID: PMC6048423 DOI: 10.3748/wjg.v24.i26.2806] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.
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Affiliation(s)
- Kazuya Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Masafumi Oya
- Department of Pathology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Tadashi Koga
- Department of Surgery, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Yuki Shiratsuchi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
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