Overview
Subepithelial lesions (SEL) of the gastrointestinal tract encompass a spectrum of benign and potentially malignant entities, including tumors and cysts, often discovered incidentally during endoscopy or imaging 12.Diagnosis
Endoscopic Ultrasound (EUS): Recommended for solid nonlipomatous SEL to enhance diagnostic accuracy 2.
Tissue Acquisition: EUS with tissue acquisition or fine-needle biopsy/aspiration with rapid on-site evaluation for solid SEL 2.
Grading: Utilize EUS for detailed characterization and tissue sampling to differentiate benign from malignant lesions 2.Management
Endoscopic Full-Thickness Resection: Recommended technique for managing SEL, particularly when malignancy is suspected or confirmed 1.
Resection Criteria: Suggest resection for gastric gastrointestinal stromal tumors (GIST) >2 cm and all nongastric GIST due to malignant potential 2.
Gastric GIST <2 cm: Insufficient evidence to recommend routine surveillance versus resection 2.Special Populations
No Specific Guidelines: Abstracts do not provide specific recommendations for pregnancy, pediatrics, elderly, or patients with comorbidities 12.Key Recommendations
Employ endoscopic ultrasound (EUS) with tissue acquisition for diagnostic evaluation of solid nonlipomatous subepithelial lesions (Evidence: Strong 2).
Resect gastric gastrointestinal stromal tumors (GIST) larger than 2 cm and all nongastric GIST due to malignant potential (Evidence: Moderate 2).
Consider endoscopic full-thickness resection for definitive management of subepithelial lesions when malignancy is suspected or confirmed (Evidence: Expert opinion 1).References
1 D'Souza LS, Yang D, Diehl D. AGA Clinical Practice Update on Endoscopic Full-Thickness Resection for the Management of Gastrointestinal Subepithelial Lesions: Commentary. Gastroenterology 2024. link
2 Jacobson BC, Bhatt A, Greer KB, Lee LS, Park WG, Sauer BG et al.. ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions. The American journal of gastroenterology 2023. link