Utility of Endoscopic Ultrasound for
the Diagnosis and Treatment of Submucosal Tumors of the Upper
Gastrointestinal Tract
Adrian Saftoiu1, Peter
Vilmann2, Tudorel Ciurea1
1) Department of Internal
Medicine, Division of Gastroenterology, University of Medicine
and Pharmacy Craiova, Romania; 2) Department of Surgical Gastroenterology,
Gentofte University Hospital Copenhagen, Denmark
Abstract
‘Submucosal tumors’
represent a bulge underneath the mucosa of the gastrointestinal
tract whose etiology cannot be determined by gastrointestinal
endoscopy or barium studies. Because many of these lesions do
not arise from the submucosa, these abnormalities have been
recently referred to as subepithelial lesions.
The aim of this review was
to assess the value of EUS for the diagnosis and management
of suspected subepithelial lesions.
Endoscopic ultrasound (EUS)
is currently considered the investigative procedure of choice
when a subepithelial lesion has been detected. EUS can determine
the intra- or extramural location of the lesion, can differentiate
vascular, cystic and solid lesions, and can characterize the
layer(s) of origin or ultrasound characteristics (size, borders,
homogeneity, anechoic areas or echogenic foci). EUS cannot differentiate
exactly between benign and malignant tumors, but it can guide
fine needle aspiration (FNA) biopsy or histologic needle biopsies,
thus providing samples for cytology or histological analysis.
EUS also offers valuable
information on the clinical management, and helps to decide
whether a lesion should be consequently followed, removed by
endoscopy or by surgery. The introduction of EUS and endoscopic
submucosal resection (ESMR) clearly changed the management
of small subepithelial lesions (less than 3 cm). A clinical
decision algorithm was subsequently developed, taking into
consideration the information offered by most of the reviews
and case reports. However, further prospective studies will
have to establish the value and indications of ESMR (used in
association with EUS), for the treatment of subepithelial lesions,
as compared to surgery and follow-up
Keywords
Endoscopic ultrasound -
submucosal tumors - digestive tract - diagnosis - treatment
