Mucosal Incision-Assisted Endoscopic Biopsy as an Alternative to Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy for Gastric Subepithelial Tumor

Random Lasing for Bimodal Imaging and Detection of Tumor

The interaction of light with biological tissues is an intriguing area of research that has led to the development of numerous techniques and technologies. The randomness inherent in biological tissues can trap light through multiple scattering events and provide optical feedback to generate random lasing emission. The emerging random lasing signals carry sensitive information about the scattering dynamics of the medium, which can help in identifying abnormalities in tissues, while simultaneously functioning as an illumination source for imaging. The early detection and imaging of tumor regions are crucial for the successful treatment of cancer, which is one of the major causes of mortality worldwide. In this paper, a bimodal spectroscopic and imaging system, capable of identifying and imaging tumor polyps as small as 1 mm2, is proposed and illustrated using a phantom sample for the early diagnosis of tumor growth. The far-field imaging capabilities of the developed system can enable non-contact in vivo inspections. The integration of random lasing principles with sensing and imaging modalities has the potential to provide an efficient, minimally invasive, and cost-effective means of early detection and treatment of various diseases, including cancer.

Laparoscopic transgastric enucleation of a giant leiomyoma near the esophagogastric junction: A case report

INTRODUCTION AND IMPORTANCE

Gastric subepithelial tumors are surgically treated by tumorectomy without lymphadectomy, and many operations are currently performed via the minimally invasive technique. However, when they occur near the esophagogastric junction and the pyloric ring, there is a possibility that subtotal or total gastrectomy is required for tumor resection.

CASE PRESENTATION

An 18-year-old man presented with anemia. A giant subepithelial tumor near the esophagogastric junction was seen on a gastroscopy performed to find the cause of anemia. A computed tomography scan revealed a 7.5-cm homogeneous soft tissue mass near the esophagogastric junction, suggesting leiomyoma or gastrointestinal stromal tumors as gastric subepithelial tumors. Endoscopic ultrasound revealed an inhomogeneous and hypoechoic mass, consistent with a gastrointestinal stromal tumor. An endoscopic ultrasound-guided fine needle biopsy was performed, resulting in a diagnosis of leiomyoma. We performed the laparoscopic transgastric enucleation, and the final pathology report showed complete resection of a benign leiomyoma.

CLINICAL DISCUSSION

Laparoscopic surgery may be challenging for subepithelial tumors of the esophagogastric junction, but laparoscopic transgastric enucleation may be considered if the lesion is benign after a fine needle biopsy.

CONCLUSION

We report a case of a very young patient for whom laparoscopic transgastric enucleation of a giant gastric leiomyoma near the esophagogastric junction was a feasible organ-sparing procedure.

Natural History of Asymptomatic Esophageal Subepithelial Tumors of 30 mm or Less in Size

BACKGROUND

No definite guidelines for the management of small esophageal subepithelial tumors (SETs) have been established, because there are limited data and studies on their natural history. We aimed to assess the natural history and propose optimal management strategies for small esophageal SETs.

METHODS

Patients diagnosed as esophageal SETs ≤ 30 mm in size between 2003 and 2017 using endoscopic ultrasound (EUS) with a minimal follow-up of 3 months were enrolled, and their esophagogastroduodenoscopy (EGD) and EUS were retrospectively reviewed.

RESULTS

Of 275 esophageal SETs in 262 patients, the initial size was < 10 mm, 10-20 mm, and 20-30 mm in 104 (37.8%), 105 (38.2%), and 66 (24.0%) lesions, respectively. Only 22 (8.0%) SETs showed significant changes in size and/or echogenicity and/or morphology at a median of 40 months (range, 4-120 months). Tissues of 6 SETs showing interval changes were obtained using EUS-guided fine needle aspiration biopsy; 1 was identified as a gastrointestinal stromal tumor (GIST) and was surgically resected, while the other 5 were leiomyomas and were regularly observed. Eight SETs showing interval changes were resected surgically or endoscopically without pathological confirmation; 1 was a GIST, 2 were granular cell tumors, and the other 5 were leiomyomas.

CONCLUSION

Regular follow-up with EGD or EUS may be necessary for esophageal SETs ≤ 30 mm in size considering that small portion of them has a possibility of malignant potential. When esophageal SETs ≤ 30 mm show significant interval changes, pathological confirmation may precede treatment to avoid unnecessary resection.

Prediction of Gastric Gastrointestinal Stromal Tumors before Operation: A Retrospective Analysis of Gastric Subepithelial Tumors

Gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas are the most common gastric subepithelial tumors (GSETs) with similar endoscopic findings. Preoperative prediction of GSETs is difficult. This study analyzed and predicted GSET diagnosis through a retrospective review of 395 patients who underwent surgical resection of GISTs, leiomyomas, and schwannomas measuring 2–10 cm. GSETs were divided by size (group 2–5, >2 and ≤5 cm; group 5–10, >5 and ≤10 cm) for analysis. Demographics, clinical symptoms, and images were analyzed. A recursive partitioning analysis (RPA) was used to identify optimal classifications for specific GSET diagnoses. GIST patients were relatively older than other patients. Both groups had higher proportions of UGI bleeding, lower hemoglobin (Hb) levels, and a higher ratio of necrosis on their computed tomography (CT) scans. The RPA tree showed that (a) age ≤ 55, Hb ≥ 10.7, and CT necrosis; (b) age ≤ 55 and Hb < 10.7; (c) age >55 and Hb < 12.9; and (d) age >55 and CT hetero-/homogeneity can predict high GIST risk in group 2–5. Positive or negative CT necrosis, with age >55, can predict high GIST risk in group 5–10. GIST patients were older and presented with low Hb levels and tumor necrosis. In RPA, the accuracy reached 85% and 89% in groups 2–5 and 5–10, respectively.